Stenting of critical aortic coarctation in neonates between 600 and 1,350 g. Using a transfemoral artery approach. A single center experience

Abstract

BackgroundStenting of aortic coarctation (CoA) in newborns with a very low bodyweight remains rare and challenging. In this study we aim to highlight on two points: first the feasibility of CoA stenting in such babies and second the importance of using echocardiogram for guiding the intervention without the need for contrast agent.MethodsBetween 2020 and 2022 three preterm babies with very low (VLWB) and extremely low weight (ELWB) underwent CoA-stenting in our center. The weight of the patients at time of intervention was 1,350, 1,200, and 600 g, respectively. The femoral artery was chosen in all patients as vascular access. Transthoracic echocardiography, sonography of the femoral arteries and head ultrasound were applied for follow up.ResultsAll three interventions were successfully done, with no complications. Coronary stents were implanted. In one Patient (1,350 g) the stent was inserted without sheath. In two patients with renal failure, the stenting was performed under echocardiography-guidance without contrast agent. The follow up showed a preserved function of the left ventricle in all patients. No relevant gradient was reported and no stent re-intervention was required. Sonographic follow up showed a patent femoral artery in all patients. Two patients were operated 73 and 110 days after stenting, and the stents were successfully removed. In the third patient the intervention was performed 130 days ago and he is waiting for the operation.ConclusionCoA-stenting in VLWB and ELWB is feasible and can bridge them to the next surgery without complications. Echocardiography-guided CoA-stenting in VLWB is a considerate option especially in patients with renal failure. Accessing the femoral artery by experienced doctors, using local anesthesia before the puncture and before removing the sheath might help to protect the vessel from stenosis or occlusion.

Fluoroscopy-free, echocardiography-guided hybrid stenting of native aortic coarctation in a 920-grams premature infant

“…In previous reports of balloon dilation and/or primary stenting of coarctation in extremely low-birth-weight infants, vascular access varied including umbilical artery, 2 femoral artery, 3,4 axillary artery, and femoral or carotid artery surgical cut-down. Umbilical artery access was no longer available in our patient.…”

“…Umbilical artery access was no longer available in our patient. Although feasible, 3,4 femoral artery access carries a high risk of arterial spasm and femoral artery occlusion in extremely low-birth-weight infants, with 5/5 patients (gestational age: 29 weeks [27–32], procedural weight: 1200-grams [680–1380]) having occlusion of the femoral artery used for intervention in a recent series. 3 In our case, we preferred surgical cut-down of the right common carotid artery as neonatal cardiac interventions via percutaneous common carotid artery access have been shown to be effective and safe, with no acute change in cerebral perfusion.…”

Transcatheter Interventions for Neonates with Congenital Heart Disease: A Review

“…Considering that smaller and younger patients have a greater rate of restenosis, stent implantation is another palliative measure for preterm neonates with CoA. After the first report in 2002 by Radtke et al, with the use of rigid bare metal stent [ 75 ], CoA stenting using pre-mounted coronary stents became a safe alternative to treat the acute symptoms and to bridge the patients to surgery [ 76 , 77 ]. The surgical repair, including stent removal, can then be performed once the patient has reached a sufficient body weight.…”

Percutaneous closure of simple congenital heart diseases under echocardiographic guidance

“…One challenge faced by this new technology is how to apply it in low-weight or vascular dysplasia infants and young children. Notedly, Mini et al [ 82 , 83 ] reported echocardiogram guidance stenting of the aortic arch in very- low and extremely-low weight babies (600 g to 1300 g) with renal failure and showed that the interventions in such babies were feasible and can be done at the bedside to avoid transfer such babies to the cath lab. However, there is no experience in other CHDs.…”