Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation

Abstract

BackgroundSurgical treatment of critical aortic coarctation (CoA) is difficult in very low birth weight (VLBW) infants ≤1500 g and preferably postponed until 3 kg with prostaglandins (PGE). ObjectivesTo investigate the procedure and outcome of primary coronary stent implantation as bridging therapy to surgery in VLBW infants with CoA. MethodsRetrospective evaluation of primary CoA stenting in VLBW infants from 2010 to 2015. ResultsFive VLBW infants with a median gestational age of 29 weeks (27–32) underwent primary CoA stenting. Indication was cardiac failure in 4 and severe hypertension in 1 patient. Age and weight at intervention were 14 days (range 12–16) and 1200 g (680–1380), respectively. Stent diameter ranged 3–5 mm. The femoral artery used for intervention was occluded in all infants without clinical compromise. Severe restenosis and aneurysm occurred in 1 VLBW infant and was successfully treated with covered coronary stents. Median age at surgical correction was 200 days (111–804) and weight 5500 g (4500–11,400). No reinterventions were required during a median postoperative follow-up of 2.8 years (0.1–5.0). Neurodevelopmental outcomes were normal and comparable between patients and siblings (4/5 gemelli). ConclusionsPrimary coronary stent implantation in VLBW infants with critical CoA is a feasible bridging therapy to surgery.