What is the best option for 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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In a multi-institutional study of 350 patients, Forbes et al [147] compared surgery, balloon angioplasty, and stent implantation for treatment of native aortic coarctation and demonstrated improvement in all 3 groups both acutely and at follow-up. However, the stent group had fewer complications (compared with surgical and balloon angioplasty patients), shorter hospitalization (compared with surgical patients), and lower coarctation gradients at follow-up (compared with balloon patients), but had higher “planned” reintervention (compared with surgical and balloon patients).

The study [147] is flawed in that there were a disproportionally large number of patients in the stent group (217, stent; 61, balloon angioplasty; 72, surgery), small number of patients followed (35.7%, with less than 75% of these patients having had imaging studies), and presumed noninclusion of all eligible patients into the study. Significant age and weight differences (P< .001) between study groups were found, although the authors attempted to address this issue by including an analysis of a subgroup of patients aged 6-12 years. Equally disturbing is the nonrandomized nature of the study. The authors, however, correctly concluded that these results should be interpreted with caution, which could be amended to “great” caution.

Instead of debating which treatment is better, it is prudent to tailor the treatment depending on the age of the patient and the pathology (anatomy) of the coarctation and the surrounding region. Most cardiologists prefer surgical intervention for treatment of neonatal and infant (< 1 y) coarctations. Children older than 1 year with discrete native coarctation are candidates for balloon dilatation. If the coarctation segment is long, surgical treatment in younger children and stents in adolescents and adults would seem appropriate.

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