Vol.3 - No.2

Comparison of surgical and interventional therapy of native and recurrent aortic coarc-tation regarding different age groups during childhood

By : baghaei

Keywords : Aortic coarctation, Pediatric cardiac surgery,Stent, Trans-catheter treatment, Balloon dilatation.

The aim of the study was to analyze immediate
results, rate of complications and re-interventions during
medium-term outcome in pediatric patients with native or
recurrent aortic coarctation. We focused on an age-related
therapeutic approach comparing surgical and trans-catheter
treatment.

Methods

This is a retrospective, single-centre, clinical observational
trial including 91 consecutive patients (age: 1
day-18 years) treated for native coarctation in 67 and recurrent
aortic coarctation in 24 patients. Surgical treatment was

performed in 56, trans-catheter treatment with balloon dilatation

in 17, and by stent implantation in 18 patients. According

to the age groups, we treated 48 children in group

A (<6 months of age), 16 in group B (6 months–6 years),

and 27 in group C (>6 years). A total of 41 patients in group

A were operated (85%), patients in group B received either

surgical or trans-catheter treatment (50% vs 50%), and

16 patients in group C were treated by stent implantation

(62%).

Results

Immediate results were excellent with a signifi-cant release of pressure gradient in all three age groups
(64.7% in group A, 69.1% in group B, and 63.3% in group
C). Complication rate and re-intervention rate (surgical and
interventional) were both comparable between the three age
groups (complications: group A 8.3%, group B 6.3%, and
group C 3.7%; re-interventions: group A 16.6%, group B
18.8%, and group C 18.5%). Midterm outcome after a median
follow-up period of 17.5 months was satisfactory with
a re-intervention-free survival after 17.5 months of 83.4%,
81.2%, and 81.5% in group A, group B, and group C, respectively.

Conclusion

The current strategy of an age-related therapy for native and recurrent aortic coarctation in our institution
is surgery in infants <6 months (group A), either surgery
or balloon dilatation in younger patients <6 years (group
B), while in older children >6 years of age (group C) the
trans-catheter treatment with stent implantation is an excellent
alternative to surgery. Balloon dilatations showed limited
results with an overall re-intervention rate of 53% and,
therefore, should mainly be performed as a rescue procedure
or in recurrent aortic coarctation in neonates.

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