Author + information
- 1Massachusetts General Hospital/Brigham and Women's Hospital, Boston, Massachusetts, United States
- 2Nationwide Children's Hospital, Columbus, Ohio, United States
- 3University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
- 4Children's Hospital - Harvard Medical School, Boston, Massachusetts, United States
We aim to determine practice patterns and acute outcomes of aortic coarctation interventions, based on age, in the largest multi-center registry for congenital heart catheterization.
We analyzed coarctation procedures performed between 2011 and 2016 in the Improving Pediatric and Adult Congenital Treatment (IMPACT) Registry from the American College of Cardiology National Cardiovascular Data Registry. Procedures were examined by age groups: neonates (<28 days), infants (29 days-1 yr), children (1-8 yrs and 9-12 yrs), adolescents (13-17 yrs) and adults (≥18 yrs). Demographic and procedural characteristics were collected. The combined endpoint of major adverse events (MAEs) included death, cardiac arrest, embolic stroke within 72 hours, device malposition or thrombus requiring surgery, device embolization requiring retrieval, vascular complications requiring treatment, unplanned surgery due to catheterization, event requiring LVAD or ECMO, and subsequent cardiac catheterization due to procedure.
Over the study period, 3467 coarctation procedures were attempted, with the majority being in infants (0.5% in neonates, 38.7% in infants, 20.8% in children aged 1-8 yrs, 10.9% in children aged 9-12 yrs, 15.8% in adolescents, 13.4% in adults). Single ventricle physiology was common (24% overall, 39.5% in infants, 5.4% in adults). By childhood (age 1-8 years), more than half of patients had had a prior catheterization or surgery. The procedures were elective for over 95% of patients older than 1, but urgent, emergency or salvage for 67% of neonates and 27.7% of infants. Procedural indication varied with age, with high resting gradient being the most common in neonates and infants (44% and 57%) and systemic hypertension in adolescents and adults (35% and 42%, p<0.001). Balloon angioplasty was the most common procedure in infants (92%), becoming less common with increasing age (p<0.001, Figure 1). Stent implantation was performed in a third of neonates, uncommonly in infants and young children, and in the majority of children and adults over the age of 8. The defect was successfully treated in 99.2% of all patients (ranging from 98.7% in adults to 100% in neonates), with a mean post-procedure peak systolic gradient of 7.8 +/- 9.9 mmHg overall, compared to a 25.6 +/- 16.1 mmHg mean pre-procedural gradient. MAEs were most common in neonates (25%) and infants (8%); they were less common but increased with age in the other age groups, from 1.8% in children aged 1-8 to 4.3% in adults (p<0.001). The most common MAE in neonates were cardiac arrest during the procedure (n=2, 13%) and in-hospital death (n=4, 25%), whereas they were vascular complications (n=34, 2.5%) and in-hospital death (n=49, 3.7%) in infants. Bleeding events were most common in adults (4.1% vs. 0; 1.6%; 1.8%; 2.1%; and 3.3% in the other age groups, p<0.001).
Catheter interventions for treatment of coarctation are performed safely in infants, older children and adults and with a high degree of acute procedural success. Stent implantation is commonly performed in children over the age of 8 but was also performed in over a third of neonates.
STRUCTURAL: Congenital and Other Structural Heart Disease