SURGICAL VERSUS INTERVENTIONAL THERAPY OF NATIVE AND RECURRENT AORTIC COARCTATION IN CHILDHOOD

Abstract

Background: The long-term results of coarctation (CoA) whether native or recurrent , have been
described for adolescents and adults , but the influence of age, especially in the younger pediatric
population, on the outcome of treatment has not been fully determined .Objective: The aims of the
study were:1- To analyse immediate results, rate of complications and re-interventions after mediumterm
follow up in pediatric patients with native or recurrent aortic coarctation 2- To evaluate the agerelated
therapeutic approach for CoA . Methods: This is a retrospective, single centre, clinical
observational trial .This work focused on an age-related therapeutic approach comparing surgical and
trans-catheter treatment including 51 patients (age:5 days-14 years) treated for native coarctation.
Results: Studied patients were divided into 3 groups based on their age; 24 children in group I (< 6
months of age), 11 in group II (6 months-6 years), and 16 in group III (> 6 years) .Medical records,
angiographies, echocardio-graphic and hemodynamic data were reviewed. Further follow-up was
obtained by clinical evaluation (blood pressure gradient between upper and lower extremities).Twenty
six surgical procedures were performed (25 for native and 1 for re-COA) , 60 balloon dilatations (51
for native and 9 for re-COA) and 14 stent implantations were made (all for native COA). Fifty one
balloon dilatations were initially made for native coarctation ( 24 in group I , 11 in group II &16 in
group III ) of which 14 patients underwent stent implantation ( 1 in group I , 1 in group II &12 in
group III ) and 25 patients were surgically repaired ( 20 in group I & 5 in group II ). A significant
drop of pressure gradient occurred in all age groups (71.7% in group I , 69.7 % in group II, and 66.5 %
in group III ). Rate of surgical complication & rate of re-intervention were comparable among the
three age groups (complications: group I; 8.3 %, group II; 9.1 %,and group III; 6.25 % ; reintervention
rates were 20.8%, 18.2%, and 18.75% in groups I , II & III respectively). Conclusions: A
convenient strategy of an age-related therapy for native and recurrent aortic coarctation is surgery in
infants <6 months (group I), either surgery or balloon dilatation in patients 6 months-6 years (group II
),while in older children >6 years of age (group III ) the trans-catheter treatment with stent
implantation is an excellent alternative to surgery