Follow-Up Outcomes and Effectiveness of Stent Implantation for Aortic Coarctation: A Systematic Review and Meta-Analysis Publisher Pubmed

Summary: Meta of 66 studies/3880 patients: stents succeed 92-96% for aortic coarctation, low complications, 97% 3-yr survival. Works in babies too—age affects outcomes! #HeartStent #CongenitalHeart

Ahmadi A¹ ; Mansourian M^{1, 2} ; Sabri MR¹ ; Ghaderian M¹ ; Karimi R² ; Roustazadeh R³
Source: Current Problems in Cardiology Published:2024

Abstract

Background: The authors aim to investigate the clinical implications of stent use for the management of CoA. Methods: All observational studies on stent implantation for the treatment of aortic coarctation and the relevant RCTs were systematically retrieved. Outcomes included the immediate success rate, pre- and post-stent gradient, survival, minor and major complications, restenosis, post-stent systolic blood pressure, and reintervention rate. The analysis was further stratified by CoA type, stent type, and the mean age of the patients. Results: Our meta-analysis incorporated 66 eligible studies involving 3,880 patients. The success rates for stent placement, defined as achieving post-treatment gradients of ≤20 mmHg and 10 mmHg, 0.96 (95% CI: 0.95 – 0.97; I2 = 59.83%) and 0.92 (95% CI: 0.89 − 0.95, I2 = 77.63%) respectively. The complication rates were quite low, with minor and major complication rates of 0.017 (95% CI: 0.013 – 0.021) and 0.007 (95% CI: 0.005 – 0.009), respectively. Unplanned reinterventions were required at a rate of 0.021 (95% CI: 0.015 – 0.026). At a mean follow-up of 2.9 years, 97% of the patients survived and 28% remained on antihypertensive therapy. While immediate effectiveness was consistent across age groups, complications were more prevalent in patients aged <20 years, and long-term efficacy was lower in those aged >20 years. Encouragingly, in neonates and infants, CoA stenting yielded results comparable to those observed in older children. Conclusion: These findings underscore the overall favorable outcomes of stent placement for aortic coarctation, with considerations for age-related variations in complications and long-term efficacy. © 2024