PDF(Pubmed)
Abstract：
UNASSIGNED: Although surgical repair was the traditional first-line treatment for native coarctation of the aorta (CoA), balloon angioplasty (BA) and stenting are now increasingly being performed. We aimed to determine the practice patterns and acute outcomes of transcatheter interventions for native coarctation in the largest multicenter registry for congenital catheterization.
UNASSIGNED: CoA interventions from the IMPACT (IMproving Pediatric and Adult Congenital Treatment) National Cardiovascular Data Registry were analyzed. The procedure choice and acute outcomes were compared among patients with no prior interventions on the aortic isthmus (native CoA). Procedural success was defined as no major adverse events (MAEs) and a final peak gradient of <20 mm Hg and optimal outcome as no MAEs and a final gradient of <10 mm Hg.
UNASSIGNED: Over the 8-year study period, 5928 CoA procedures were performed, of which 1187 were performed in patients with native CoA. In this group, stenting was performed in more then half of children aged >1 year and >90% of those aged >8 years. Procedural success was achieved in >90% of stenting procedures but in only 69% of BAs. Stent implantation was associated with a higher likelihood of optimal gradient (<10 mm Hg) after adjustment for age and baseline characteristics. MAEs were most common in children aged <1 year (14%), occurred in 2% to 2.5% of those aged 1 to 18 years and in 6.6% of adults (P < .001), and were more likely after BA than after stenting (odds ratio, 0.5; 95% CI, 0.28-0.9; unadjusted P = .02).
UNASSIGNED: Catheter interventions for native coarctation are performed safely in older children and adults, with a high degree of immediate procedural success, particularly with stenting.
UNASSIGNED: CoA interventions from the IMPACT (IMproving Pediatric and Adult Congenital Treatment) National Cardiovascular Data Registry were analyzed. The procedure choice and acute outcomes were compared among patients with no prior interventions on the aortic isthmus (native CoA). Procedural success was defined as no major adverse events (MAEs) and a final peak gradient of <20 mm Hg and optimal outcome as no MAEs and a final gradient of <10 mm Hg.
UNASSIGNED: Over the 8-year study period, 5928 CoA procedures were performed, of which 1187 were performed in patients with native CoA. In this group, stenting was performed in more then half of children aged >1 year and >90% of those aged >8 years. Procedural success was achieved in >90% of stenting procedures but in only 69% of BAs. Stent implantation was associated with a higher likelihood of optimal gradient (<10 mm Hg) after adjustment for age and baseline characteristics. MAEs were most common in children aged <1 year (14%), occurred in 2% to 2.5% of those aged 1 to 18 years and in 6.6% of adults (P < .001), and were more likely after BA than after stenting (odds ratio, 0.5; 95% CI, 0.28-0.9; unadjusted P = .02).
UNASSIGNED: Catheter interventions for native coarctation are performed safely in older children and adults, with a high degree of immediate procedural success, particularly with stenting.
摘要：
■尽管手术修复是主动脉天然缩窄（CoA）的传统一线治疗方法，现在越来越多地进行球囊血管成形术(BA)和支架置入术.我们的目的是在最大的先天性导管插入术多中心注册表中确定经导管介入治疗天然缩窄的实践模式和急性结局。
■分析了IMPACT（改良儿科和成人先天性治疗）国家心血管数据注册的CoA干预措施。在未对主动脉峡部（天然CoA）进行干预的患者中，比较了手术选择和急性结局。手术成功定义为无主要不良事件(MAEs)且最终峰值梯度<20mmHg,最佳结果为无MAEs且最终梯度<10mmHg。
■在8年的研究期间，进行了5928次CoA程序，其中1187例在天然CoA患者中进行。在这个群体中,超过一半的>1岁儿童和>90%的>8岁儿童进行了支架置入术.在>90％的支架置入程序中，仅在69％的BA中获得了程序成功。调整年龄和基线特征后，支架植入与最佳梯度（<10mmHg）的可能性更高相关。MAE在1岁以下的儿童中最常见（14％），2％至2.5％的1至18岁人群和6.6％的成年人（P<.001），并且在BA后比支架置入后更有可能(赔率比，0.5；95%CI，0.28-0.9；未调整P=.02）。
■对年龄较大的儿童和成人安全地进行局部缩窄的导管干预，在程序上取得了高度的成功，特别是支架。
■分析了IMPACT（改良儿科和成人先天性治疗）国家心血管数据注册的CoA干预措施。在未对主动脉峡部（天然CoA）进行干预的患者中，比较了手术选择和急性结局。手术成功定义为无主要不良事件(MAEs)且最终峰值梯度<20mmHg,最佳结果为无MAEs且最终梯度<10mmHg。
■在8年的研究期间，进行了5928次CoA程序，其中1187例在天然CoA患者中进行。在这个群体中,超过一半的>1岁儿童和>90%的>8岁儿童进行了支架置入术.在>90％的支架置入程序中，仅在69％的BA中获得了程序成功。调整年龄和基线特征后，支架植入与最佳梯度（<10mmHg）的可能性更高相关。MAE在1岁以下的儿童中最常见（14％），2％至2.5％的1至18岁人群和6.6％的成年人（P<.001），并且在BA后比支架置入后更有可能(赔率比，0.5；95%CI，0.28-0.9；未调整P=.02）。
■对年龄较大的儿童和成人安全地进行局部缩窄的导管干预，在程序上取得了高度的成功，特别是支架。
