Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis
ObjectivesBalloon dilation followed by balloon-expandable stent implantation is an effective treatment for improving hemodynamic status in patients with coarctation of the aorta (CoA). However, limited evidence exists regarding the safety and efficacy of covered balloon-expandable stents (CBSs) in a...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1439458/full |
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| author | Fei He Zhongze Cao Chen Wang Shyamal Premaratne Shyamal Premaratne Benjamin W. Starnes Chang Shu Chang Shu Wayne W. Zhang |
| author_facet | Fei He Zhongze Cao Chen Wang Shyamal Premaratne Shyamal Premaratne Benjamin W. Starnes Chang Shu Chang Shu Wayne W. Zhang |
| author_sort | Fei He |
| collection | DOAJ |
| description | ObjectivesBalloon dilation followed by balloon-expandable stent implantation is an effective treatment for improving hemodynamic status in patients with coarctation of the aorta (CoA). However, limited evidence exists regarding the safety and efficacy of covered balloon-expandable stents (CBSs) in a large cohort. In this meta-analysis, we aimed to evaluate the overall success rates, hemodynamic and anatomical benefits, complications, and mid-term results of CBSs in treating CoA.MethodsThe PubMed, Embase, and Cochrane Library databases were systemically searched for studies reporting outcomes of CBSs in treating CoA. Single-group rate meta-analyses were performed to calculate estimated pooled procedural success rates, the incidence of complications, and re-coarctation rates. A meta-analysis using standardized mean differences was conducted to compare pre- and postoperative trans-coarctation pressure gradients (PGs), coarctation diameter, and overall changes in systolic blood pressure (SBP). Subgroup analyses were performed to identify potential sources of heterogeneity.ResultsThe final analysis included 12 studies with a total of 411 patients. The estimated pooled procedural success rate was 100% [95% confidence interval (CI): 98%–100%, I2 = 0, P = 0.78]. Significant decreases in trans-coarctation PGs and SBP were observed. The pooled incidences of stent-related, aortic, and access site complications were 2% (95% CI: 0%–5%, I2 = 30.4%, P = 0.15), 2% (95% CI: 0%–4%, I2 = 0%, P = 0.76), and 3% (95% CI: 1%–7%, I2 = 52.9%, P = 0.02), respectively. Subgroup analyses showed that implantation of BeGraft stents was related to a significantly higher incidence of access site complications.ConclusionCovered balloon-expandable stent implantation in treating CoA is safe and effective with high procedural success rates, an acceptable incidence of complications, and a low incidence of re-coarctation.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42023430356). |
| format | Article |
| id | doaj-art-bb53de1c00a743708d32ba1d749fc777 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-bb53de1c00a743708d32ba1d749fc7772025-08-20T02:17:00ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-10-011110.3389/fcvm.2024.14394581439458Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysisFei He0Zhongze Cao1Chen Wang2Shyamal Premaratne3Shyamal Premaratne4Benjamin W. Starnes5Chang Shu6Chang Shu7Wayne W. Zhang8Department of Vascular Surgery, Huaihe Hospital, Henan University, Kaifong, Henan, ChinaCenter of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Vascular Surgery, Huaihe Hospital, Henan University, Kaifong, Henan, ChinaHunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, United StatesVirginia Union University, Richmond, VA, United StatesDivision of Vascular and Endovascular Surgery, University of Washington, Seattle, WA, United StatesCenter of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Vascular Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, ChinaDivision of Vascular and Endovascular Surgery, University of Washington, Seattle, WA, United StatesObjectivesBalloon dilation followed by balloon-expandable stent implantation is an effective treatment for improving hemodynamic status in patients with coarctation of the aorta (CoA). However, limited evidence exists regarding the safety and efficacy of covered balloon-expandable stents (CBSs) in a large cohort. In this meta-analysis, we aimed to evaluate the overall success rates, hemodynamic and anatomical benefits, complications, and mid-term results of CBSs in treating CoA.MethodsThe PubMed, Embase, and Cochrane Library databases were systemically searched for studies reporting outcomes of CBSs in treating CoA. Single-group rate meta-analyses were performed to calculate estimated pooled procedural success rates, the incidence of complications, and re-coarctation rates. A meta-analysis using standardized mean differences was conducted to compare pre- and postoperative trans-coarctation pressure gradients (PGs), coarctation diameter, and overall changes in systolic blood pressure (SBP). Subgroup analyses were performed to identify potential sources of heterogeneity.ResultsThe final analysis included 12 studies with a total of 411 patients. The estimated pooled procedural success rate was 100% [95% confidence interval (CI): 98%–100%, I2 = 0, P = 0.78]. Significant decreases in trans-coarctation PGs and SBP were observed. The pooled incidences of stent-related, aortic, and access site complications were 2% (95% CI: 0%–5%, I2 = 30.4%, P = 0.15), 2% (95% CI: 0%–4%, I2 = 0%, P = 0.76), and 3% (95% CI: 1%–7%, I2 = 52.9%, P = 0.02), respectively. Subgroup analyses showed that implantation of BeGraft stents was related to a significantly higher incidence of access site complications.ConclusionCovered balloon-expandable stent implantation in treating CoA is safe and effective with high procedural success rates, an acceptable incidence of complications, and a low incidence of re-coarctation.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42023430356).https://www.frontiersin.org/articles/10.3389/fcvm.2024.1439458/fullaortic coarctationendovascularstentingcongenital heart diseasehypertension |
| spellingShingle | Fei He Zhongze Cao Chen Wang Shyamal Premaratne Shyamal Premaratne Benjamin W. Starnes Chang Shu Chang Shu Wayne W. Zhang Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis Frontiers in Cardiovascular Medicine aortic coarctation endovascular stenting congenital heart disease hypertension |
| title | Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis |
| title_full | Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis |
| title_fullStr | Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis |
| title_full_unstemmed | Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis |
| title_short | Endovascular treatment of aortic coarctation using covered balloon-expandable stents—a systematic review and meta-analysis |
| title_sort | endovascular treatment of aortic coarctation using covered balloon expandable stents a systematic review and meta analysis |
| topic | aortic coarctation endovascular stenting congenital heart disease hypertension |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1439458/full |
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