Background:In recent decades,aortic stenting has become a promising alternative to surgery for both native aortic coarctation and re-stenosis in children and adults.However,comparative long-term outcomes have poorly b...Background:In recent decades,aortic stenting has become a promising alternative to surgery for both native aortic coarctation and re-stenosis in children and adults.However,comparative long-term outcomes have poorly been investigated.Methods:We included 212 patients with previous aortic repair(19±8.7 years)divided into 3 groups:139 with single-time surgical repair(CoA-S group);18 with single-time percutaneous stenting(CoA-PS group);and 55 hybrid patients with multiple aortic procedures because of re-coarctation occurrence(CoA-H group).All patients underwent 24-hour ambulatory blood pressure monitoring and trans-thoracic echocardiography.Results:After a median follow-up of 17 years after aortic repair,antihypertensive therapy was recorded in a significantly higher proportion of patients(83%)in CoA-PS group compared to 65%and 46%of CoA-H and CoA-S groups,respectively(p=0.002).Pulse pressure values were higher in CoA-PS patients compared to the others(p<0.001).Echocardiogram showed significant residual aortic gradient in 50%of CoA-PS and 73%of CoA-H patients compared to 33%of CoA-S patients(p<0.0001).Indeed,stenting was associated to higher incidence of re-coartaction(p<0.0001).At multivariate regression Cox analysis adjusted for age at repair and need for antihypertensive therapy,percutaneous stenting was an independent predictor of echocardiographic evidence of re-coarctation(p≤0.001).Conclusion:Aortic coarctation stenting was independently associated with re-coartaction occurrence during long-term follow up when compared to surgical procedures.Furthermore,patients with aortic stenting had lower blood pressure control at 24-hour ambulatory blood pressure monitoring and higher need for antihypertensive therapy.展开更多
文摘Background:In recent decades,aortic stenting has become a promising alternative to surgery for both native aortic coarctation and re-stenosis in children and adults.However,comparative long-term outcomes have poorly been investigated.Methods:We included 212 patients with previous aortic repair(19±8.7 years)divided into 3 groups:139 with single-time surgical repair(CoA-S group);18 with single-time percutaneous stenting(CoA-PS group);and 55 hybrid patients with multiple aortic procedures because of re-coarctation occurrence(CoA-H group).All patients underwent 24-hour ambulatory blood pressure monitoring and trans-thoracic echocardiography.Results:After a median follow-up of 17 years after aortic repair,antihypertensive therapy was recorded in a significantly higher proportion of patients(83%)in CoA-PS group compared to 65%and 46%of CoA-H and CoA-S groups,respectively(p=0.002).Pulse pressure values were higher in CoA-PS patients compared to the others(p<0.001).Echocardiogram showed significant residual aortic gradient in 50%of CoA-PS and 73%of CoA-H patients compared to 33%of CoA-S patients(p<0.0001).Indeed,stenting was associated to higher incidence of re-coartaction(p<0.0001).At multivariate regression Cox analysis adjusted for age at repair and need for antihypertensive therapy,percutaneous stenting was an independent predictor of echocardiographic evidence of re-coarctation(p≤0.001).Conclusion:Aortic coarctation stenting was independently associated with re-coartaction occurrence during long-term follow up when compared to surgical procedures.Furthermore,patients with aortic stenting had lower blood pressure control at 24-hour ambulatory blood pressure monitoring and higher need for antihypertensive therapy.
