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Bailout Stenting Successful Treatment for Infants With Constricted Aortas HOBOKEN, NJ -- March 19, 2010 -- Cardiac interventionalists and surgeons have achieved successful stent implantation and follow-up coarctectomy in premature infants suffering from aortic coarctation. Full findings are published in the March issue of the journal Catheterization and Cardiovascular Interventions. Prostaglandin E1 infusion is the standard treatment to recover or maintain systemic flow in a neonate with critical coarctation prior to elective surgical repair. However, this treatment may not restore sufficient blood flow in time and can be associated with considerable side effects when given for a prolonged time. A research team led by Marc Gewillig, MD, University Clinic in Leuven, Leuven, Belgium evaluated the safety and efficacy of stenting a coarcted aortic arch in critically ill neonates in order to defer corrective surgery until the infants had stabilised and gained weight “Significant arch obstruction in critically ill infants currently requires a surgical intervention, but how and when to proceed with the surgery is crucial to successful outcomes,” said Dr. Gewillig. “Our goal of stenting the coarctation was to provide the surgeon with a bigger and better patient for surgery to correct the arch obstruction.” The study covered 15 infants aged younger than 2 months between January 1998 and March 30, 2009. The infants were born between 30 to 41 weeks of gestation; 8 out of 15 were premature (<37 weeks of gestation). At cardiac catheterisation, the average weight of the patients was 2.5 kg and their mean age was 12 days. One group of patients had a native coarctation where surgery was not considered the best option at that time (very low-birth-weight, critically ill neonates not responding to medical treatment, complex cardiac, and noncardiac disease); a second group consisted of patients with significant early restenosis after primary surgical coarctectomy or arch repair. Stent removal and arch reconstruction has been performed in 12 patients. One patient is still awaiting final repair. In patients with simple stented coarctation, the stent was removed after 2.8 months. In complex cardiac malformation, stents were removed after 3.0 months. The decision when to remove the stent was made for every patient individually: criteria were haemodynamic stability after the cardiogenic shock, adequate body weight to safely perform coarctectomy, or when additional surgery was planned. Most patients with simple coarctation could easily be weaned from supportive therapy as systemic output had adequately resumed. Two deaths occurred before stent removal and were nonprocedure related. “The surgeon felt the procedure was not complicated by the presence of the stent and the surgery was easier to perform as all structures had grown, with some catch-up growth of the distal arch,” said Dr. Gewillig. “This study shows that early stenting (of both native coarctation or early recoarctation post surgical coarctectomy) in critically ill infants followed by later coarctectomy can be performed safely and with good results,” he concluded. SOURCE: Wiley-Blackwell E-mail this page to a friend or colleague! To print, use this version