University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu).
JACC Cardiovasc Interv. 2023 Feb 27;16(4):444-453. doi: 10.1016/j.jcin.2022.11.007.
Coarctation of the aorta (CoA), a congenital narrowing of the proximal descending thoracic aorta, is a relatively common form of congenital heart disease. Untreated significant CoA has a major impact on morbidity and mortality. In the past 3 decades, transcatheter intervention (TCI) for CoA has evolved as an alternative to surgery.
The authors report on all TCIs for CoA performed from 2000 to 2016 in 4 countries covering 25 million inhabitants, with a mean follow-up duration of 6.9 years.
During the study period, 683 interventions were performed on 542 patients.
The procedural success rate was 88%, with 9% considered partly successful. Complications at the intervention site occurred in 3.5% of interventions and at the access site in 3.5%. There was no in-hospital mortality. During follow-up, TCI for CoA reduced the presence of hypertension significantly from 73% to 34%, but despite this, many patients remained hypertensive and in need of continuous antihypertensive treatment. Moreover, 8% to 9% of patients needed aortic and/or aortic valve surgery during follow-up.
TCI for CoA can be performed with a low risk for complications. Lifetime follow-up after TCI for CoA seems warranted.
主动脉缩窄（CoA）是近端降主动脉先天性狭窄的一种相对常见的先天性心脏病。未经治疗的严重 CoA 对发病率和死亡率有重大影响。在过去的 30 年中，经导管介入（TCI）已成为治疗 CoA 的一种替代方法。
作者报告了 2000 年至 2016 年间在覆盖 2500 万居民的 4 个国家进行的所有 CoA 的 TCI，平均随访时间为 6.9 年。
在研究期间，对 542 名患者进行了 683 次介入治疗。
手术成功率为 88%，其中 9%被认为部分成功。介入部位并发症发生率为 3.5%，介入部位并发症发生率为 3.5%。无院内死亡。随访期间，TCI 治疗 CoA 使高血压的发生率从 73%显著降低至 34%，但尽管如此，许多患者仍患有高血压并需要持续降压治疗。此外，8%至 9%的患者在随访期间需要主动脉和/或主动脉瓣手术。
TCI 治疗 CoA 并发症风险低。CoA 的 TCI 治疗后进行终生随访似乎是合理的。
