Objective: In selected neonates, primary stent implantation may be indicated for coarctation
of the aorta. We describe our experience with five consecutive patients.
Methods: Five neonates in decompensated heart failure (age range: 6–11 days, weight at procedure:
2,100–4,200 g) underwent stent implantation as primary therapy for coarctation of
the aorta. Indications for primary stenting were: cardiac shock due to prostaglandin
resistant duct occlusion (n = 2), associated severe aortic valve stenosis (n = 1), distal arch hypoplasia and associated large ventricular septal defect (n = 2) requiring mayor surgery. Minimal isthmus diameter was 0.8 and 1.5 mm. Vascular
access was achieved via femoral artery (4 F sheath) in one patient and via axillary
artery (5F Gliedesheath Terumo) in the reminder. Pro-Kinetic Energy coronary stents
(Biotronik, 3.5 and 5 mm, length: 13 mm) were implanted in 2 patients and Eq. 418
vascular stents (Cook, 5 mm, length: 12 and 20 mm) in 3 patients. In one patient the
lesion was predilated with a 2.5-mm coronary balloon. In one patient the aortic valve
was dilated during the same procedure with a 7-mm balloon.
Results: All procedures were acutely successful with relief of heart failure, and without
procedural dissection, aneurysms, serious complications or death. Femoral arterial
stenosis occurred in the patient with femoral arterial access and one periprocedural
stroke resolved without residue. Four patients showed no postprocedural gradient;
1 patient had a residual gradient of 10 mm Hg with anatomic narrowing. 3 stents have
been removed 6 to 129 days (median = 111 days) after placement (2 coronary stents
and 1 Formula stent). The hypoplastic arch grew adequately in the two patients where
the stent remained longer in place and patch enlargement could be avoided during follow
up surgery. The patients with in-situ remaining stents show good results at a median
follow-up of 10 months. One expandable Formula stent has been redilated with an 8
mm Balloon 234 days after placement.
Conclusion: Primary stenting of neonatal coarctation is a good alternative to surgery for babies
with unstable hemodynamics and concomitant complex congenital heart disease. Access
is best via the right axillary artery to avoid vascular injury. As the 5 mm formula
stent is delivered through a small 5 F Terumo sheath, can be redilated to 12 mm and
is breakable beyond that diameter, neonatal stenting of aortic coarctation is valid
for definitive treatment.
