Optimal aortic arch stentino in the young adult.

Abstract

Management of Coa in childhood results in resolution of hyperten- sion(hbp) and pressure gradients. Development of hbp, arch(aa) distortion(aad), aa hypoplasia(haa) indexed (with minimal gradients) often occur in adulthood. Comprehensive stenting of aa results in improved z scores and resolution/improvement of hbp and aa distortion(recently reported.) Aim: review techniques of aa stenting and outcomes. Method and Results: records of all patients stented from 2000 to 2010/ 11 were analysed. There were 31 pts. aged 12-29 yrs, 21M,10F (16sflap, 7 native coa, 6 end to end anastomosis, 2 primary haa) 9 pts had multiple procedures and 21 had multiple stents. Temporary rv pacing, long sheath placement with improved balloon/stents helped in optimising results. 8 pts had stents in proximal haa with jailing of left carotid artery origin (origin ballooned). Others had stents implanted in distal arch/isthmus to desired z dimensions. 9 pts needed high pressure balloon(atlas conquest) to stretch resistant arch (1 failure). 1 pt had stent embolisation proximally to asc. Ao needing surgical rescue. 1 pt had trivial intima tear. 2 pts had stent embolisation distally, parked well. 6/8 pts with aad were improved. Hbp settled in 16 pts. and were improved in the remainder. Conclusion(s): 1. Proximal aa stents can be implanted safely. 2. Comprehensive indexed stenting of aa appear necessary to improve/settle hbp. 3. Aad and resistant haa can be improved. 4. Long term effects of aa stenting remain unclear thus far.