TY - JOUR
T1 - Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta
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
PY - 2011/12/13
Y1 - 2011/12/13
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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U2 - 10.1016/j.jacc.2011.08.053
DO - 10.1016/j.jacc.2011.08.053
M3 - Article
C2 - 22152954
AN - SCOPUS:82955207685
SN - 0735-1097
VL - 58
SP - 2664
EP - 2674
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -