P-073 - STENTING FOR AORTIC COARCTATION MANAGEMENT IN ADULTS

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Nana P. (Department of Vascular Surgery, Larissa University Hospital ~ Larissa ~ Greece) , Spanos K. (Department of Vascular Surgery, Larissa University Hospital ~ Larissa ~ Greece) , Brodis A. (Neurosurgery Department, Larissa University Hospital ~ Larissa ~ Greece) , Kouvelos G. (Department of Vascular Surgery, Larissa University Hospital ~ Larissa ~ Greece) , Rickers C. (German Aortic Center Hamburg, Department of Vascular Medicine ~ Hamburg ~ Germany) , Kozlik-Feldmann R. (German Aortic Center Hamburg, Department of Vascular Medicine ~ Hamburg ~ Germany) , Giannoukas A. (Department of Vascular Surgery, Larissa University Hospital ~ Larissa ~ Greece) , Kolbel T. (German Aortic Center Hamburg, Department of Vascular Medicine ~ Hamburg ~ Germany)
Introduction:
Aortic coarctation (CoA) is one of the commonest congenital cardiovascular diseases. Open surgical repair has established its role in the treatment of CoA while endovascular treatment constitutes a valuable alternative with low early morbidity and mortality, despite the increased risk of restenosis and need for re-intervention. The aim of this systematic review was to assess the available literature on stenting for the management of CoA in adult population in terms of technical success, intra-operative complications, and re-intervention and mortality during the peri-operative period and follow-up.
Methods:
The protocol was registered to the PROSPERO, according to the PRISMA statement and PICO model. An English literature data search was conducted, using PubMed, EMBASE and CENTRAL, until 12.30.2021. Only studies reporting on stenting, for native or recurrent CoA, in adults were included. Studies reporting on children or adolescents, iatrogenic or traumatic coarctation, coarctation located at the aortic arch or abdominal aorta, or presenting results of less than five patients were excluded. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Primary outcomes were technical success, intra-operative pressure gradient and complications, and 30-day mortality, while secondary were re-interventions and mortality during follow-up.
Results:
Twenty-seven manuscripts and 705 patients were included (64.0% males, mean age 34.0 years). Native CoA was present in 65.7%. 714 stents were deployed: 20.8% self-expanding bare metal, 5.9% self-expanding covered, 43.5% balloon expandable bare metal and 29.8% balloon expandable covered stents. Technical success was 96.7% (Table 1). Six (0.9%) ruptures and ten dissections (1.4%) were reported. The intra-operative and 30-day mortality were 0.4 and 0.8%, respectively. Peak pressure gradient before stenting ranged between 19.0-68.4 mmHg and after, between 0.0-15.7mmHg. The median follow-up was 29 months. Sixty-eight re-interventions (10.4%) were performed; 95.5% were endovascular. Seven deaths were reported. Regarding the risk of bias, it should be acknowledged that most studies were of retrospective nature. Ten studies were considered of high quality and the remaining 17 studies were characterized as low quality, as a variety of confounders was detected including the small number of cases, differentiation of technical details, surgeon and patients selection and limited follow-up period.
Conclusion:
Stenting for CoA in adults presents high technical success and the intra-operative and 30-day mortality rates are <1.0%. The pressure gradient decreased immediately after deployment. During the mid-term follow-up, the re-intervention rate is acceptable, and mortality remains low.
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