Stent Implantation for Aortic Coarctation in Small Children: Midterm Results of 101 Patients without Reoperations after up to 11 Years of Follow-up

Background: Stent implantation is the golden standard for the treatment of native coarctation of aorta (CoA) and re-CoA in patients, where a stent dilatable to an adult size can be used. However, stent implantation in smaller children remains a challenge, and data regarding the optimal treatment strategy for these patients are very limited.

Methods: Between April 2010 and January 2024, 101 patients (male n = 63) with a body weight less than 15 kg and contraindications for surgery were treated with endovascular stent implantation for re-CoA (n = 94) or native CoA (n = 7). The mean age at the time of stent implantation was 8.7 months (range 0.2–44.8) with a mean body weight of 6.8 kg (range 0.9–15) and a mean height of 66 cm (range 38–103). The primary diagnosis included hypoplastic left heart syndrome (n = 33), hypoplastic aortic arch (n = 23), isolated aortic coarctation (n = 28), Shone complex (n = 2), interrupted aortic arch (n = 5), and other complex congenital heart diseases (n = 10). Prior to stent implantation, 17 patients underwent balloon angioplasty, which did not achieve long-lasting success. Demographic characteristics as well as details about the procedures and outcomes were collected retrospectively.

Results: All procedures were successful and no serious complications occurred. The stents used in this study included Cook Formula stent (n = 88), Coroflex Blue coronary stent (n = 1), Onyx stent (n = 1), Osypka baby stent (n = 4), Mega LD (n = 2), Bentley coronary stent 5 mm (n = 1), Optimus L stent (n = 2), Palmaz Blue 6 mm (n = 2). Peak-to-peak gradient decreased significantly from a mean of 34 mm Hg to a mean of 2 mm Hg (p < 0.005). The narrow segment was dilated from a mean of 3.1 mm (min. 1.0; max. 6.6) to 7.0 mm (min. 3.5; max. 11.0). During a mean follow-up of 47 months (range 1–132) 64 patients required one, 27 patients required two, and 9 patients required three reinterventions. Intentional fracturing of the implanted stent has been performed in three patients. No patient had to be reoperated so far.

Conclusion: Stent implantation is a safe and feasible treatment modality in patients with re-CoA or native CoA who have contraindications for surgery. However, further studies with longer follow-up periods are needed to determine the optimal timing for re-dilation and treatment of these patients.

Publication History

Article published online:
11 February 2025