Introduction: Surgical repair of critical coarctation can be problematic in premature-critical-early postoperative-syndromatic neonates. Primary stent implantation allows to buy time and postpone surgery.
Patients: 18 neonates with severe coarctation: 5 premature-dysmature (1400-2000g), 5 syndromatic-complex malformation, 4 early (< 24h) and 4 late (4-8 weeks) after surgical coarctectomy.
Methods:A 4F (in 2 pts 5F) short introducer sheath in femoral artery; heparin 100U/kg; angiogram; a 0.014” wire in the arch (in 1 patient coarctation was crossed anterograde). Bare coronary stents (diameter 4.0 [3.5-6.0] mm; length 12 [8-16] mm) advanced through 4F sheath; position controlled before deployment by retrograde sequential contrast-saline injection through sheath. In 2 patients an additional stent was put in the cross. Stents were removed surgically depending on clinical needs.
Results: Adequate aortic flow was obtained in 17 patients; additional 8 mm balloon dilation in 1 patient after 6 days; femoral artery preserved in 16/18 patients; 2 deaths non-procedure related (1 severe syndromic, 1 endocarditis post sepsis). In patients with simple stented coarctation the stent was removed after 2.2 (0.2 – 4.0) months. In complex cardiac malformation, additional delay obtained by stent dilation with 7-8 mm balloon after 20(5–38) months; the stent finally removed 20(5 – 38) months after implantation. Surgical technique: end-to-end in 7, extensive arch patch reconstruction in 7; 2 pts are awaiting stent removal. Final gradient across arch 0 – 20 mmHg Doppler in all patients.
Conclusions: In premature/critical/complex syndromic neonates with severe coarctation, bailout stenting followed by early or late surgical coarctectomy appears a promising concept.