SPC365

Two decades of effective stent implantation in aortic coarctation patients: a single-center cohort study of long-term hypertensive burden

Session: Comunicações Orais - Sessão 02 - Doença aórtica
Speaker: Mariana Sousa Paiva

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.7 Valvular Heart Disease - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Mariana Sousa Paiva; Isabel Sampaio Graça; Maria Estevens; João Rato; Inês Carmo Mendes; Susana Cordeiro; Mafalda Sequeira; Rui M. Anjos

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Introduction:</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Aortic coarctation (AoCo) patients often grapple with persistent hypertension, even after effective interventions. Stent implantation has emerged as a promising solution. Our aim was to describe the burden of hypertension in AoCo patients following stent implantation during long-term follow-up (FUP) and to identify determinants of persistent hypertension.</span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Methods:</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Single-center retrospective cohort including AoCo patients who underwent successful stent implantation </span>(persistent residual isthmic Doppler gradient &le; 20mmHg) from 1998-2020 and were followed for over 3 years (1072 patient-years, median FUP 13 years). Data on clinical and echocardiographic assessment, resting blood pressure (BP) measurement, and 24-h ambulatory blood pressure monitoring were collected. Linear regression analyses <span style="color:black">were performed to explore the association between clinical variables and persistent hypertension at long-term FUP. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Results:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">We followed &nbsp;86 patients (mean age 29&plusmn;15 years at the time of stenting, 61% men, 58 patients (67%) with native coarctation). Before stenting, all patients were on antihypertensive therapy, with 62 (72%) on multiple drugs.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Patients with native AoCo were significantly older (32&plusmn;16 vs. 23&plusmn;13 yo, p=0.012) and had an inferior minimal diameter of AoCo (5.3&plusmn;3.1 vs. 8.3&plusmn;3.2, p&lt;0.01).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Invasive gradients significantly decreased 42.6&plusmn;20.8 to 4.8&plusmn;6.5 mmHg after stenting (p=0.008). &nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Eighteen patients (21%) underwent a second procedure either for multistage procedure (n=5), to treat recoil or neointima hyperplasia (n=5), patient growth (4) or stent fracture.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">At long-term follow-up, 73 patients (85%) remained hypertensive. However, in 62 (84.9%) of them, it was possible to discontinue at least one antihypertensive drug (fig. 1A). Age at the time of stenting was the only predictor of persistent hypertension (&beta; 0.77 95%CI 0.60-0.94, p&lt;0.001) at this time point.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Patients who remained medication free were younger (24.5&plusmn;12.0 vs 32.7&plusmn;16.9 years, p=0.014), had a lower initial Doppler gradient (35.5&plusmn;15.6 vs 48.0&plusmn;22.8 mmHg, p=0.050), and lower invasive gradient before intervention (42.6&plusmn;14.0 vs 49&plusmn;16 mmHg, p=0.029) (fig. 1B). </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Mean left ventricular mass index (LVMI) significantly reduced over the FUP , from 120.7 g/m<sup>2</sup> to 107.8 g/m<sup>2</sup> at 1-year FUP to 98.0 g/m<sup>2</sup> at long-term FUP (all p&lt;0.001).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Over 20 years, there were 6 deaths (7%), of whom 5 did not reach health adjusted life expectancy.</span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">On long term FUP, while the majority of our cohort remained hypertensive, it was possible to reduce the burden of the disease by discontinuing at least one </span>antihypertensive drug in most of the patients. <span style="color:black">Age emerged as the sole predictor of persistent hypertension. </span>These findings highlight the importance of pursuing an aggressive screening and treatment of hypertension in these patients even after successful stent implantation.</span></span></p>