Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta

An observational study by the CCISC (Congenital cardiovascular interventional study consortium)

Thomas J. Forbes, Dennis W. Kim, Wei Du, Daniel R. Turner, Ralf Holzer, Zahid Amin, Ziyad Hijazi, Abdolrahim Ghasemi, Jonathan J. Rome, David Nykanen, Evan Zahn, Collin Cowley, Mark Hoyer, David Waight, Daniel Gruenstein, Alex Javois, Susan Foerster, Jacqueline Kreutzer, Nancy Sullivan, Asra Khan & 5 others Carl Owada, Donald Hagler, Scott Lim, Joshua Canter, Thomas Zellers

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation acutely and at follow-up. Background: Controversy surrounds the optimal treatment for native coarctation of the aorta. This is the first multicenter study evaluating acute and follow-up outcomes of these 3 treatment options in children weighing >10 kg. Methods: This is a multicenter observational study. Baseline, acute, short-term (3 to 18 months), and intermediate (>18 months) follow-up hemodynamic, imaging data, and complications were recorded. Results: Between June 2002 and July 2009, 350 patients from 36 institutions were enrolled: 217 underwent stent, 61 underwent BA, and 72 underwent surgery. All 3 arms showed significant improvement acutely and at follow-up in resting systolic blood pressure and upper to lower extremity systolic blood pressure gradient (ULG). Stent was superior to BA in achieving lower ULG acutely. Surgery and stent were superior to BA at short-term follow-up in achieving lower ULG. Stent patients had shorter hospitalization than surgical patients (2.4 vs. 6.4 days; p < 0.001) and fewer complications than surgical and BA patients (2.3%, 8.1%, and 9.8%; p < 0.001). The BA patients were more likely to encounter aortic wall injury, both acutely and at follow-up (p < 0.001). Conclusions: Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution.

Original languageEnglish (US)
Pages (from-to)2664-2674
Number of pages11
JournalJournal of the American College of Cardiology
Volume58
Issue number25
DOIs
StatePublished - Dec 13 2011
Externally publishedYes

Fingerprint

Aortic Coarctation
Balloon Angioplasty
Stents
Observational Studies
Blood Pressure
Therapeutics
Multicenter Studies
Hemodynamics
Thoracic Aorta
Lower Extremity
Hospitalization
Arm
Safety

Keywords

  • aortic coarctation
  • balloon angioplasty
  • stent
  • surgical treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta : An observational study by the CCISC (Congenital cardiovascular interventional study consortium). / Forbes, Thomas J.; Kim, Dennis W.; Du, Wei; Turner, Daniel R.; Holzer, Ralf; Amin, Zahid; Hijazi, Ziyad; Ghasemi, Abdolrahim; Rome, Jonathan J.; Nykanen, David; Zahn, Evan; Cowley, Collin; Hoyer, Mark; Waight, David; Gruenstein, Daniel; Javois, Alex; Foerster, Susan; Kreutzer, Jacqueline; Sullivan, Nancy; Khan, Asra; Owada, Carl; Hagler, Donald; Lim, Scott; Canter, Joshua; Zellers, Thomas.

In: Journal of the American College of Cardiology, Vol. 58, No. 25, 13.12.2011, p. 2664-2674.

Research output: Contribution to journalArticle

Forbes, TJ, Kim, DW, Du, W, Turner, DR, Holzer, R, Amin, Z, Hijazi, Z, Ghasemi, A, Rome, JJ, Nykanen, D, Zahn, E, Cowley, C, Hoyer, M, Waight, D, Gruenstein, D, Javois, A, Foerster, S, Kreutzer, J, Sullivan, N, Khan, A, Owada, C, Hagler, D, Lim, S, Canter, J & Zellers, T 2011, 'Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: An observational study by the CCISC (Congenital cardiovascular interventional study consortium)', Journal of the American College of Cardiology, vol. 58, no. 25, pp. 2664-2674. https://doi.org/10.1016/j.jacc.2011.08.053
Forbes, Thomas J. ; Kim, Dennis W. ; Du, Wei ; Turner, Daniel R. ; Holzer, Ralf ; Amin, Zahid ; Hijazi, Ziyad ; Ghasemi, Abdolrahim ; Rome, Jonathan J. ; Nykanen, David ; Zahn, Evan ; Cowley, Collin ; Hoyer, Mark ; Waight, David ; Gruenstein, Daniel ; Javois, Alex ; Foerster, Susan ; Kreutzer, Jacqueline ; Sullivan, Nancy ; Khan, Asra ; Owada, Carl ; Hagler, Donald ; Lim, Scott ; Canter, Joshua ; Zellers, Thomas. / Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta : An observational study by the CCISC (Congenital cardiovascular interventional study consortium). In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 25. pp. 2664-2674.
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T2 - An observational study by the CCISC (Congenital cardiovascular interventional study consortium)

AU - Forbes, Thomas J.

AU - Kim, Dennis W.

AU - Du, Wei

AU - Turner, Daniel R.

AU - Holzer, Ralf

AU - Amin, Zahid

AU - Hijazi, Ziyad

AU - Ghasemi, Abdolrahim

AU - Rome, Jonathan J.

AU - Nykanen, David

AU - Zahn, Evan

AU - Cowley, Collin

AU - Hoyer, Mark

AU - Waight, David

AU - Gruenstein, Daniel

AU - Javois, Alex

AU - Foerster, Susan

AU - Kreutzer, Jacqueline

AU - Sullivan, Nancy

AU - Khan, Asra

AU - Owada, Carl

AU - Hagler, Donald

AU - Lim, Scott

AU - Canter, Joshua

AU - Zellers, Thomas

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N2 - Objectives: The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation acutely and at follow-up. Background: Controversy surrounds the optimal treatment for native coarctation of the aorta. This is the first multicenter study evaluating acute and follow-up outcomes of these 3 treatment options in children weighing >10 kg. Methods: This is a multicenter observational study. Baseline, acute, short-term (3 to 18 months), and intermediate (>18 months) follow-up hemodynamic, imaging data, and complications were recorded. Results: Between June 2002 and July 2009, 350 patients from 36 institutions were enrolled: 217 underwent stent, 61 underwent BA, and 72 underwent surgery. All 3 arms showed significant improvement acutely and at follow-up in resting systolic blood pressure and upper to lower extremity systolic blood pressure gradient (ULG). Stent was superior to BA in achieving lower ULG acutely. Surgery and stent were superior to BA at short-term follow-up in achieving lower ULG. Stent patients had shorter hospitalization than surgical patients (2.4 vs. 6.4 days; p < 0.001) and fewer complications than surgical and BA patients (2.3%, 8.1%, and 9.8%; p < 0.001). The BA patients were more likely to encounter aortic wall injury, both acutely and at follow-up (p < 0.001). Conclusions: Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution.

AB - Objectives: The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation acutely and at follow-up. Background: Controversy surrounds the optimal treatment for native coarctation of the aorta. This is the first multicenter study evaluating acute and follow-up outcomes of these 3 treatment options in children weighing >10 kg. Methods: This is a multicenter observational study. Baseline, acute, short-term (3 to 18 months), and intermediate (>18 months) follow-up hemodynamic, imaging data, and complications were recorded. Results: Between June 2002 and July 2009, 350 patients from 36 institutions were enrolled: 217 underwent stent, 61 underwent BA, and 72 underwent surgery. All 3 arms showed significant improvement acutely and at follow-up in resting systolic blood pressure and upper to lower extremity systolic blood pressure gradient (ULG). Stent was superior to BA in achieving lower ULG acutely. Surgery and stent were superior to BA at short-term follow-up in achieving lower ULG. Stent patients had shorter hospitalization than surgical patients (2.4 vs. 6.4 days; p < 0.001) and fewer complications than surgical and BA patients (2.3%, 8.1%, and 9.8%; p < 0.001). The BA patients were more likely to encounter aortic wall injury, both acutely and at follow-up (p < 0.001). Conclusions: Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution.

KW - aortic coarctation

KW - balloon angioplasty

KW - stent

KW - surgical treatment

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