The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Long term follow-up of patients with aortic arch atresia post recanalization

DOI: 10.4244/EIJ-D-18-00857

1. Pediatric and Adult Congenital Heart Center - IRCCS-Policlinico San Donato Milan, Italy, ITALY
2. Pediatric and Adult Congenital Heart Centre- IRCCS-Policlinico San Donato Milan, Italy
3. Pediatric Cardiac Surgery Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
4. Pediatric and Adult Congenital Heart Centre- IRCCS-Policlinico San Donato Milan, Italy
5. Hospital Universitario de Cruces, Sección de Hemodinámica y Cardiología Intervencionista, Baracaldo, Vizcaya, Spain
6. Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Germany
7. Pediatric and Adult Congenital Heart Centre- IRCCS-Policlinico San Donato Milan, Italy
8. Pediatric Cardiology Department, Santa Marta Hospital, CHLC, Lisbon, Portugal
9. Pediatric Cardiology Department, Santa Marta Hospital, CHLC, Lisbon, Portugal
10. Paediatric Cardiology & Adult Congenital Heart Diseases Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
11. Paediatric Cardiology & Adult Congenital Heart Diseases Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Aims:Aortic arch atresia (AAA) is one of the rarest obstructive defects. Presence of this anomaly in adult age is also uncommon. The typical anatomic feature consists of a complete occlusion of the membranous obstruction resulting in an acquired atresia without flow continuity between proximal and distal segments. This feature is important in determining the feasibility of percutaneous intervention. We present a long term follow up of 19 patients with ‘AAA’ who underwent successful percutaneous recanalization with covered stents.

Methods and results:Retrospective data of 19 patients (12 male, 63.2%, mean age: 32.2 years ± 18.9 years) diagnosed with ‘AAA’ treated in five different centers between 1999 to 2017 were collected. All patients underwent percutaneous recanalization by (1) radiofrequency system (RF) (five patients, 26.3%), (2) extra-stiff guide wire (12 patients, 63.2%) and (3) trans-septal needle (two patients, 10.5%). All procedures were subsequently followed by covered stent implantation. Two patients developed complications during the procedure and one of them died. Over a median follow-up of 4.94 years, four (21%) patients were able to wean medications for hypertension. All the patients underwent reassessment for recurrence or restenosis during the follow up. Seven (36.8%) patients underwent successful stent dilatation with a balloon. After the intervention, one patient experienced a late complication, however, one patient died due to an unknown cause believed to be unrelated to the previous recanalization procedure.

Conclusions:Percutaneous treatment of ‘AAA’ is feasible with good long-term survival. This study reports the largest case series as per available literature, so far.

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