Stent Therapy for Aortic Coarctation in Children

Abstract

To report our experience of coarctation stent therapy in small children weighing less than 30kg, with the low profile dilatable Valeo stent and review the literature on coarctation stent therapy in this patient population. Coarctation stent implantation was undertaken in 14 consecutive children using the Bard Valeo Stent. Demographic, angiographic, echocardiographic and clinical data were reviewed retrospectively. The median age at the time of procedure was 5.1 (2.6-7.5)years and median weight was 20.8 (14.7-27)kg. There was improvement in median coarctation diameter from 4 (1.3-5.2) to 9.5 (5.8-12.7)mm, p<0.001; and a reduction in the median peak pressure gradient across the coarctation from 35 (20-49) to 9 (0-15)mmHg, p<0.001. Median stent recoil was 7.9 (0-20)%. There was one case of access related complication that resolved without sequelae. Follow-up was a median of 15 (3.0-57.2)months. CT angiogram performed at a median time of 3.3 (2.6-10.2)months post procedure showed no aortic wall injury and preserved stent integrity in all cases. Two children underwent re-intervention for stent dilation and further stent implantation due to in-stent stenosis and somatic growth after 3years. Six of fourteen children remained on a single antihypertensive agent post-intervention at last follow-up. Implantation of the dilatable Valeo stent is a feasible treatment strategy in native or recurrent coarctation in small children, accepting that additional stent implantation may be necessary with somatic growth. Further study is required to determine longer-term stent efficacy and clinical outcome.