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Procedural Characteristics and Outcomes of Transcatheter Interventions for Aortic Coarctation: A Report From the
Ada C Stefanescu Schmidt1, Aimee Armstrong2, Kevin F Kennedy3
1Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
Insights
Transcatheter interventions for native coarctation of the aorta are safe and effective, especially stenting in older children and adults. Balloon angioplasty shows lower success rates and higher risks compared to stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Coarctation of the aorta (CoA) traditionally treated with surgery.
- Transcatheter interventions like balloon angioplasty (BA) and stenting are increasingly used for native CoA.
- Largest multicenter registry data for congenital catheterization used to assess practice patterns and outcomes.
Purpose of the Study:
- To determine practice patterns and acute outcomes of transcatheter interventions for native coarctation.
- To compare procedural choice and outcomes between BA and stenting.
- To analyze data from the IMPACT registry for native CoA interventions.
Main Methods:
- Analysis of CoA interventions from the IMPACT National Cardiovascular Data Registry.
- Comparison of procedure choice and acute outcomes in patients with native CoA.
- Definition of procedural success (<20 mm Hg gradient) and optimal outcome (<10 mm Hg gradient), with no major adverse events (MAEs).
Main Results:
- Over 8 years, 1187 native CoA procedures were analyzed; stenting was predominant in older children.
- Procedural success was >90% for stenting versus 69% for BA.
- Major adverse events (MAEs) were most frequent in infants (<1 year) and more common after BA than stenting.
Conclusions:
- Transcatheter interventions for native coarctation are safe in older children and adults.
- Stenting demonstrates a high degree of immediate procedural success.
- Balloon angioplasty is associated with lower success rates and higher MAEs compared to stenting.
Background:
Although surgical repair was the traditional first-line treatment for native coarctation of the aorta (CoA), balloon angioplasty (BA) and stenting are now increasingly being performed. We aimed to determine the practice patterns and acute outcomes of transcatheter interventions for native coarctation in the largest multicenter registry for congenital catheterization.
Methods:
CoA interventions from the IMPACT (IMproving Pediatric and Adult Congenital Treatment) National Cardiovascular Data Registry were analyzed. The procedure choice and acute outcomes were compared among patients with no prior interventions on the aortic isthmus (native CoA). Procedural success was defined as no major adverse events (MAEs) and a final peak gradient of <20 mm Hg and optimal outcome as no MAEs and a final gradient of <10 mm Hg.
Results:
Over the 8-year study period, 5928 CoA procedures were performed, of which 1187 were performed in patients with native CoA. In this group, stenting was performed in more then half of children aged >1 year and >90% of those aged >8 years. Procedural success was achieved in >90% of stenting procedures but in only 69% of BAs. Stent implantation was associated with a higher likelihood of optimal gradient (<10 mm Hg) after adjustment for age and baseline characteristics. MAEs were most common in children aged <1 year (14%), occurred in 2% to 2.5% of those aged 1 to 18 years and in 6.6% of adults (P < .001), and were more likely after BA than after stenting (odds ratio, 0.5; 95% CI, 0.28-0.9; unadjusted P = .02).
Conclusions:
Catheter interventions for native coarctation are performed safely in older children and adults, with a high degree of immediate procedural success, particularly with stenting.
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