Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery

Abstract

Background:Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature.Methods:The study design was a retrospective record review. Patients with coarctation aged <1 year who underwent balloon or surgical coarctoplasty at our center (January 2010–January 2016) with >6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted.Results:Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan–Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028).Conclusion:In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.

Transcatheter Intervention for Coarctation of Aorta: Current Status

“…Percutaneous angioplasty was done by P S Rao et al 10, 14 to control heart failure or hypertension in 51 infants and neonates less than 3 months of age. Additional surgery was required to achieve optimal gradient in 7.8% neonates.…”

“…Balloon diameter should not be more than 1 to 2 mm of diameter at isthmus, or 50% of aortic diameter at the level of diaphragm, or 2 to 3 times the narrowed segment diameter and length should be less than 3 cm. 9, 10 Balloon is gently inflated at 3 to 4 atmosphere or until waist disappears for 5 seconds, 2 to 3 times 5 minutes apart. If balloon waist doesn’t disappear at 1 to 2 atmosphere, don’t inflate it further, as it may lead to catastrophe.…”

Proposed method for evaluation and categorization of functional capacity of children, adolescents, and adults with cardiac diseases to bring them in existing social justice system by creating the cardiac disability criteria

“…Up to 25% of complex CHDs may present with HF in adulthood [4,26,27]. The operated patients may also have suboptimal FC in the presence of residual defects, ventricular dysfunction, chronotropic incompetence, tachyarrhythmia, heart block, SAH, PAH, PVH, prosthesis implantation, post-cardiac transplant deconditioning, IE, and co-existing multi-organ dysfunction [2,[22][23][24][25][28][29][30][31][32][33][34][35][36][37][38][39][40]. These patients need to undergo evaluation of cardiac disability based on a scoring system utilizing existing subjective and objective parameters, for the assessment of functional capacity [11][12][13]20].…”

“…The information obtained from echo or other imaging modalities is pertinent to diagnosis and are ancillary to the overall assessment of functional capacity. Nevertheless, functional capacity as we know is the ability to initiate and sustain accustomed and unaccustomed exercise, indicating the efficiency of the integrated functioning of the cardiovascular-pulmonary unit, in the presence of a cardiac disease [19][20][21][22][23][24][25][26][27][28][29]. Determination of peak VO2/ METs in response to exercise (submaximal treadmill or bicycle exercise testing) or 6-, 9-, and 12-min walk tests are the objective methods described in the literature to assess FC of a patient with the compromised cardiac status [44][45][46][47][48][49][50].…”

Determination of Factors Affecting the Results of Balloon Angioplasty in Coarctation of Aorta

“…Buna rağmen son 20 yıldır balon anjiyoplasti ve stent yerleştirme işlemi gibi kateter yoluyla yapılan girişimsel tedaviler yaygınlaşmıştır. [1][2][3] Daha önce yapılan çalışmalarda, transvers arkus ve istmus çap Z-skorunun koarktasyon balon anjiyoplasti başarısını etkileyen en önemli faktör olduğu, transvers arkus ve istmus çap Z-skoru büyük olan hastaların rekoarktasyon oranının daha düşük olduğu, ayrıca aortik istmus Z-skorunun, balon anjiyoplasti başarısını yaşla ilişkisiz olarak etkilediği bildirilmiştir. 4,5 Çalışmamızda, aort koarktasyonu nedeni ile balon anjiyoplasti uyguladığımız hastaları retrospektif olarak değerlendirerek; balon anjiyoplasti ile doğal koarktasyondaki 5 yıllık başarı oranımızı belirlemek, rekoarktasyona etki eden faktörleri ortaya koymak, sonuçlarımızı diğer çalışmaların sonuçlarıyla karşılaştırarak daha etkin ve uygun tedavi yaklaşımını belirlemeyi amaçladık.…”