Document Detail


Stenting of aortic coarctation: acute, intermediate, and long-term results of a prospective multi-institutional registry--Congenital Cardiovascular Interventional Study Consortium (CCISC).
MedLine Citation:
PMID:  20882661     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Since the 1980s, stent implantation has evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow-up, lack of adequate follow-up imaging, and retrospective nature of data collection.
METHODS: Data was prospectively collected using a multicenter registry congenital cardiovascular interventional study consortium (CCISC). Between 2000 and 2009, 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coarctation. Eligible patients (44%) completed intermediate follow-up (3-18 months) with integrated imaging (cath, CT, MRI), whereas 21% completed long-term follow-up (>18-60 months). Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg, lack of significant recurrent obstruction, and freedom from unplanned repeat intervention.
RESULTS: Acute procedural success was 96%. Cumulative intermediate success was 86%, and cumulative long-term success was 77%. Unplanned repeat interventions were required in 4%, and aortic wall complications were seen in 1% of patients (dissection n = 1 and aneurysm n = 3). Other adverse events (n = 15) occurred mainly acutely and included technical complications such as stent malposition (n = 9). At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th centile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication.
CONCLUSIONS: This study documented acute, intermediate, and long-term outcome data comparable or superior with other surgical or interventional series. However, even with successful initial stent therapy, patients continue to require long-term follow-up and have associated long-term morbidity, relating to aortic wall complications, systemic hypertension, recurrent obstruction as well as need for repeat intervention.
Authors:
Ralf Holzer; Shakeel Qureshi; Abdolrahim Ghasemi; Julie Vincent; Horst Sievert; Daniel Gruenstein; Howard Weber; Luis Alday; Alejandro Peirone; Thomas Zellers; John Cheatham; Michael Slack; Jonathan Rome
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  76     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  553-63     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley-Liss, Inc.
Affiliation:
The Heart Center, Nationwide Children's Hospital Columbus, Columbus, Ohio 43205, USA. Ralf.Holzer@Nationwidechildrens.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antihypertensive Agents / therapeutic use
Aortic Coarctation / complications,  diagnosis,  physiopathology,  therapy*
Argentina
Canada
Chi-Square Distribution
Child
Child, Preschool
Endovascular Procedures / adverse effects,  instrumentation*
Female
Hemodynamics
Humans
Hypertension / drug therapy,  etiology,  physiopathology
Magnetic Resonance Imaging
Male
Middle Aged
Prospective Studies
Prosthesis Design
Recurrence
Registries
Retreatment
Risk Assessment
Risk Factors
Stents*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
United States
Young Adult
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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