What are the pearls of surgical repair of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Note the following:

  • Stent therapy appears to be an attractive method for the treatment of recurrent coarctation or aneurysm formation following prior surgical or balloon intervention and for long-segment hypoplasia. Most cardiologists use stents in adolescents and adults, although a few have advocated their use in younger children. [106, 127, 128] The selection of the type of stent and the type of balloon catheter used for stent deployment appears to be evolving. Balloon-expandable stents are preferred over self-expandable stents. However, some workers used self-expandable stents successfully. [129]

  • The use of a BIB catheter for stent delivery appears to be gaining momentum in an attempt to prevent balloon ruptures and perforation of other cardiovascular structures.

  • Positioning the guide wire into the right or left subclavian artery may avoid excessive curvature and, thus, may prevent balloon rupture.

  • Flexible instead of rigid Palmaz stents are being used.

  • Selected stent diameter at implantation should be at least twice the diameter of the narrowest aortic segment to prevent stent displacement during implantation.

  • The issues related to placement of the stent across the mouths of the arch vessel still need to be resolved.

  • Relief of obstruction both short-term and at follow-up with a low incidence of major complications is well demonstrated in several studies.

  • Meticulous attention to the technique and adoption of new technology, when it becomes available, may further reduce the incidence of complications.

  • Recoarctation rate at follow-up appears to be low. Re-expansion of the stent to treat residual or recoarctation and growth-related narrowing appears feasible, safe, and effective, although this is based on limited experience. [130]

  • The few studies that have compared balloon angioplasty with stents suggest that stents may be more effective. [117, 131, 132] Similar comparison between surgery and stents indicate stenting for native coarctation of the aorta is an effective alternative to surgical intervention in older children. [133, 134]

  • Based on the available data, stenting aortic coarctation appears to be the preferred alternative to surgical or balloon therapy in adolescents and young adults.


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