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Vol. 77. Issue 4.
Pages 332-341 (April 2024)
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Vol. 77. Issue 4.
Pages 332-341 (April 2024)
Original article
Very long-term follow-up after aortic stenting for coarctation of the aorta
Seguimiento a muy largo plazo tras implante de stent en la coartación de aorta
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Manuel Pana,b,c,, Cristina Periceta,b,, Rafael González-Manzanaresa,b,
Corresponding author
rafaelglezm@gmail.com

Corresponding author.
, Manuel A. Díaza,b, Javier Suárez de Lezoa,b, Francisco Hidalgoa,b, Marco Alvaradoa,b, Guillermo Dueñasa,b, Elena Gómezd, Simona Espejoe, Jorge Pereaa,b, Miguel Romeroa,b,c, Soledad Ojedaa,b,c
a Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
c Universidad de Córdoba, Córdoba, Spain
d Servicio de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain
e Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Tables (5)
Table 1. Baseline data
Table 2. Late follow-up events
Table 3. Predictors of aortic aneurysm. Univariable and multivariable logistic regression models
Table 4. Predictors of stent fracture. Univariable and multivariable logistic regression models
Table 5. Predictors of reintervention. Univariable and multivariable Cox regression models
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Abstract
Introduction and objectives

Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting.

Methods

We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment.

Results

A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth.

Conclusions

This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.

Keywords:
Aortic coarctation
Congenital heart diseases
Aneurysm
Stent fractures
Abbreviations:
CT
Resumen
Introducción y objetivos

El implante de stent es el tratamiento de elección en niños mayores y adultos con coartación aórtica (CoA). El objetivo fue determinar la incidencia de eventos tardíos después del tratamiento con stent.

Métodos

Se analizó una cohorte de pacientes con CoA tratados en el centro entre 1993 y 2018 a los que se siguió periódicamente, incluyendo evaluación mediante tomografía computarizada (TC) y fluoroscopia.

Resultados

Se incluyó a 167 pacientes con TC y fluoroscopia: 83 (49,7%) ≤ 12 años y 46 (28%) mujeres. El tiempo medio de seguimiento clínico fue de 17±8 años (rango 4-30) y de 11±7 años hasta la TC/fluoroscopia. Se detectó aneurisma en un 13% y se asoció al stent PALMAZ (OR=3,09; IC95%, 1,11-9,49; p=0,036) y a la longitud del stent (OR=0,94; IC95%, 0,89-0,99; p=0,039). La fractura del stent fue frecuente (34%) pero no asociada a la presencia de aneurisma. Se asoció con edad joven (OR=3,57; IC95%, 1,54-8,33; p=0,003), sexo masculino (OR=4,00; IC95%, 1,51-12,50; p=0,008) e inversamente con el stent PALMAZ (OR=0,29; IC95%, 0,12-0,67; p=0,005). La reintervención fue menor en adultos (10%), principalmente por aneurismas. Los pacientes que recibieron tratamiento cuando tenían 12 años o menos presentaron tasas de reintervención más altas (43%) debido al crecimiento somático.

Conclusiones

Se observó una incidencia notable de eventos tardíos a largo plazo en pacientes con CoA tratados mediante stent. La reintervención fue más frecuente en pacientes tratados a edades más jóvenes. Parece aconsejable una vigilancia periódica mediante pruebas de imagen.

Palabras clave:
Coartación aórtica
Cardiopatías congénitas
Aneurismas
Fracturas del stent

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