288 Residual hypertension and aortic wall abnormalities at mid-term follow-up after native aortic coarctation stenting

Abstract

The feasibility of transcatheter primary stenting (TPS) to treat native aortic coarctation (Coa) is well-demonstrated as an alternative of surgical repair. However, information on mid-term follow-up remains scarce, especially regarding the frequency of systemic hypertension and the integrity of the aortic arch. We retrospectively studied the patient's outcome after TPS for Coa, paying particular attention to residual hypertension and aortic wall abnormalities, including arch obstruction, aneurysm and dissection. Since 2002, 20 patients (8 female) with Coa were treated by TPS at a median age and weight of 21 (7 to 52) years and 60 (27 to 94) kg, respectively. They were symptomatic in all cases with upper limb hypertension in 16. Twenty stents were successfully implanted and the mean peak systolic pressure gradient dropped from 31 (10 to 60) mmHg to 1,6 (0 to 15) mmHg. One major complication occurred in a patient who experienced bilateral groin hematomas, with hypotension and anemia necessitating transfusion. After a median follow-up of 2,9 (0,12 to 7,8) years, the 20 patients are asymptomatic. Residual upper limb hypertension is present in 7 cases (35%), including 3 (15%) with mild residual upper-to-lower limbs gradient (20 mmHg). One patient was successfully redilated for in-stent restenosis. By transthoracic echocardiography (n = 20), spiral computed tomography (n = 4), and magnetic resonance imaging (n = 13), there is no aortic aneurysm or dissection. TPS for Coa is successful with minimal morbidity. After mid-term follow-up, residual hypertension is similar to that observed after surgical repair, whereas aortic wall abnormalities are not encountered. Longer term follow-up is mandatory to confirm this favorable outcome.