Is endovascular repair the new gold standard for primary adult coarctation?☆

Abstract

Endovascular repair of PAAC is safe and effective and compares favourably with open surgical repair. Midterm follow-up suggests that the treatment is durable and may be an alternative to surgical repair. Although this is the largest endovascular treatment series for PAAC reported to date, additional study and follow-up are needed.

Reply to Gelpi et al.

“…We read with great interest the recent article by Wheatley III Grayson et al on the safety and effectiveness of endovascular repair for primary adult coarctation (PAAC) as an alternative to surgical repair [1]. They report excellent early and midterm results on 16 adult patients with PAAC treated with endovascular repair.…”

“…[1]. Their comments regarding management of younger patients with primary aortic coarctation (PAAC) are certainly very pertinent and succinctly express conventional management paradigms for these patients, and we congratulate them on their excellent surgical outcomes.…”

Editorial commentEndovascular repair for adult coarctation: stating the obvious!

“…Wheatley et al [1] report a successful series of angioplasty and stenting of primary coarctation in adults. They achieved an excellent technical result with a 50% increase of the aortic diameter, and an insignificant postprocedural pressure gradient.…”

Balloon Dilatation and Stenting for Aortic Coarctation

“…For variables that were statistically significantly different between groups, and other variables that were considered to have a systematic effect on outcomes, we constructed forest plots to examine any potential effect on 4 key outcomes: proportion of patients achieving a gradient reduction ≤20 mm Hg; proportion achieving a gradient reduction ≤10 mm Hg; 30-day mortality; proportion of patients with severe complications before discharge. An example is Figure 3,30,31,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] which demonstrates that for both interventions, average pretreatment blood pressure gradient ( Figure 3A) and proportion of patients with native coarctation ( Figure 3B) do not systematically influence the proportion of patients with successful treatment. Further exploration of the effect of patient baseline characteristics on key outcomes is provided in Figures SI-SXII in the Data Supplement).…”