Covered Stenting in Adult and Pediatric Patient with Native or Residual Coarctation of the Aorta

Objectives: Treatment of coarctation of the aorta (CoA) by either ballooning or stent implantation is a recommended treatment form in children and adults. It may include subatretic, aneurysmatic, surgical, or interventional pretreated aorta, where the use of a covered stent is favorable to prevent dissection, aneurysm, or rupture.

Methods: We report our midterm experience with the use of the ePTFE-tube covered cobalt-chromium stent (BeGraft, Bentley, Germany) for aortic stentgraft implantation during January 2017 until August 2019, which received CE-mark approval in December 2016.

Result: Twenty-one patients were included in this analysis with a median age of 17.1 (3.8–49) years. Twelve patients (57%) were below 18 years of age and 12 (57%) had a pretreated CoA (by either surgery or intervention). Two patients received a bypass (Art. carotis to subclavia) ca. Three months prior intervention. The median weight was 62 (18–101) kg. Precatheterization imaging was performed with either MRI or CT, followed by guidance of the catheter procedure by with 3D overlay. All stent were successfully implanted: 5 × 12/29, 2 × 14/19, 2 × 14/29, 1 × 14/59, 2 × 16/38, 2 × 16/48, 2 × 20/48, 2 × 22/48, 3 × 24/48 mm through a 9–14 Fr. sheath. Rapid pacing was performed in two, postdilatation in 12 patients with mostly high pressure balloon (12–22 mm) to achieve a postgradient <5 mm Hg. Dysfunction (aneurysm, residual gradient, and dislocation) was excluded during follow-up by using echocardiography, X-ray, RR measurement, or imaging (CT/MRI) during median follow-up time was 1.42 (0.62–2.62) years. During that time, only one patient received additional covered (10 ZIG CP) stent due to stent fracture and small endoleak after 8 month which was related to high pressure postdilatation.

Conclusion: This is the first report on a larger cohort with aortic stent-graft implantation in native or pretreated CoA with the use of the ePTFE covered cobalt–chromium stent graft. The premounted stent showed a good radial force, reliable coverage, adequate adaptation to complex anatomy, and promising function during midterm follow-up time in children and adult patients. Additional data are still necessary to demonstrate efficacy and long term performance of this stent.