European Heart Journal Advance Access originally published online on June 10, 2008
European Heart Journal 2008 29(16):2042-2048; doi:10.1093/eurheartj/ehn251
Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents
í Gilík1í Lis
3í Radvansk4
Mat
jka1 Tláskal11
kovránek1
1 Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Vúvalu 84, Prague 150 18, Czech Republic
2 Department of Paediatrics, Charles University, Prague, Czech Republic
3 Department of Imaging Methods, Charles University, Prague, Czech Republic
4 Department of Exercise Medicine, 2nd Medical School, Charles University, Prague, Czech Republic
Received 19 November 2007; revised 15 April 2008; accepted 23 May 2008; online publish-ahead-of-print 10 June 2008.
* Corresponding author. Tel: +420 224432968, Fax: +420 224432920, Email: oleg.reich{at}lfmotol.cuni.cz
Aims: To assess the efficacy, safety, and long-term results of the balloon angioplasty of recoarctation.
Methods and results: The angioplasty was performed in 99 consecutive patients aged 36 days to 32.6 years (median 268 days). Recoarctation to descending aorta diameter ratio increased from 0.44 (0.35/0.50) to 0.66 (0.57/0.77), P < 0.001. Systolic gradient was reduced from 34.0 (26.0/44.75) to 15.0 (8.25/27.0) mmHg, P < 0.001. In seven patients (7.1%) the procedure was ineffective. One patient (1%) with heart failure died within 24 h after a successful angioplasty and in another (1%) an intimal abruption necessitated surgical revision. The follow-up ranged up to 20.7 years (median 8.1 years). Actuarial probability of survival 20.7 years after the procedure was 0.91, and of reintervention-free survival was 0.44. Older age at the angioplasty was associated with a higher incidence of reinterventions (hazard ratio 1.057; 95% confidence interval 1.012–1.103; P = 0.010). The type of surgery and the recoarctation anatomy did not influence the outcome. In 69 patients aneurysm formation was studied by high-sensitive methods with only one positive finding per 462 patient-years.
Conclusion: Angioplasty is safe and effective regardless of the type of surgery used and the recoarctation anatomy. Older age at the angioplasty is associated with a higher incidence of reinterventions.
Key Words: Congenital heart defect • Coarctation of the aorta • Balloon angioplasty • Aneurysm • Long-term results