Steiner Irina, Prsa Milan
Division of Pediatric Cardiology, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
Division of Pediatric Cardiology, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
Int J Cardiol. 2021 Jan 1;322:103-106. doi: 10.1016/j.ijcard.2020.08.023. Epub 2020 Aug 13.
Coarctation of the aorta (CoA) is often treated percutaneously. The aim of this study was to describe the immediate results of percutaneous management of native aortic coarctation (NaCoA) and recoarctation of the aorta (ReCoA) at our institution.
We identified all patients with NaCoA or ReCoA who underwent percutaneous dilatation by either balloon angioplasty (BAP) or endovascular stent implantation (ESI) between 2011 and 2017. Success was defined as a residual peak-to-peak gradient (PPG) <20 mmHg or a ≥50% reduction in the gradient if the pre-intervention PPG was <20 mmHg.
63 patients (median age 6.8 years, interquartile range [IQR] 0.4-14.2) were identified. Among 11 patients with NaCoA, 7 underwent BAP and 4 had ESI, and among 52 patients with ReCoA, 42 underwent BAP and 10 had ESI. In patients with NaCoA, BAP was successful in 71%, with median PPG decreasing from 32 mmHg (IQR 25-46) to 17 mmHg (IQR 4-23) (p = .02), and ESI was successful in 100%, with median PPG decreasing from 20 mmHg (IQR 14.5-40) to 2 mmHg (IQR 0-6) (p < .01). In patients with ReCoA, BAP was successful in 69%, with median PPG decreasing from 20 mmHg (IQR 16-31.3) to 9 mmHg (IQR 0-14.3) (p < .001), and ESI was successful in 100%, with median PPG decreasing from 18 mmHg (IQR 11.5-22.8) to 0 mmHg (IQR 0-3.5) (p < .01). ESI was more successful than BAP (p = .01). There was only one complication.
Percutaneous management of CoA is safe and effective in both NaCoA and ReCoA. Stent implantation is more effective than BAP.
主动脉缩窄（CoA）常采用经皮治疗。本研究的目的是描述我院对原发性主动脉缩窄（NaCoA）和主动脉再缩窄（ReCoA）进行经皮治疗的即时结果。
我们确定了2011年至2017年间所有接受经皮球囊血管成形术（BAP）或血管内支架植入术（ESI）进行经皮扩张的NaCoA或ReCoA患者。成功定义为残余峰峰值压差（PPG）<20 mmHg，或者如果干预前PPG<20 mmHg，则压差降低≥50%。
共确定63例患者（中位年龄6.8岁，四分位间距[IQR]0.4 - 14.2）。在11例NaCoA患者中，7例行BAP，4例行ESI；在52例ReCoA患者中，42例行BAP，10例行ESI。在NaCoA患者中，BAP成功率为71%，中位PPG从32 mmHg（IQR 25 - 46）降至17 mmHg（IQR 4 - 23）（p = 0.02），ESI成功率为100%，中位PPG从20 mmHg（IQR 14.5 - 40）降至2 mmHg（IQR 0 - 6）（p < 0.01）。在ReCoA患者中，BAP成功率为69%，中位PPG从20 mmHg（IQR 16 - 31.3）降至9 mmHg（IQR 0 - 14.3）（p < 0.001），ESI成功率为100%，中位PPG从18 mmHg（IQR 11.5 - 22.8）降至0 mmHg（IQR 0 - 3.5）（p < 0.01）。ESI比BAP更成功（p = 0.01）。仅出现1例并发症。
经皮治疗CoA在NaCoA和ReCoA中均安全有效。支架植入术比BAP更有效。
