Surgical versus percutaneous treatment of aortic coarctation: new standards in an era of transcatheter repair

Abstract

Aortic coarctation is a common congenital cardiovascular defect, which can be diagnosed over a wide range of ages and with varying degrees of severity. Surgery has proven to be an effective treatment for the management of native aortic coarctation, and remains the treatment of choice in neonates. Balloon angioplasty with or without stenting has evolved rapidly over the past decade. Balloon angioplasty is the treatment of choice in children with re-coarctation, and currently available immediate results in native coarctation are similar with regards to gradient reduction as compared with surgery. However, both treatment options carry the risk of restenosis and aortic wall complications, especially after balloon angioplasty without stenting in native coarctation. On the other hand, stent implantation has shown excellent short-term results in both children beyond infancy and in adults with native coarctation. In patients with recurrent coarctation who are at high surgical risk, balloon angioplasty and stent repair offer a less invasive and equally effective method. Stent repair is preferred over balloon angioplasty in adults and outgrown children with a recurrent coarctation, as the risk for re-coarctation and aneurysm formation seems to be lower. Data with regard to long-term outcome after percutaneous treatment strategies are scarce. This review summarizes the current insights in the efficacy and safety of both surgical and transcatheter treatment options for aortic coarctation.

Percutaneous approach to a tight post-isthmic aortic coarctation: a case report and literature review

“…Long term follow-up data will be extremely useful to better define risks and benefits of the procedure, which should be performed in specialist experienced units. [13][14][15][16].…”

Severe Aortic Coarctation Incidentally Diagnosed at Breastfeeding Women with Acute Coronary Syndrome

“…However a trend exists to perform percutaneous intervention as the first choice treatment of CoA, there is no definite proof of a marked benefit for balloon angioplasty or surgery as the primary treatment of CoA for now (7). Surgery especially remains the treatment of choice in neonates (8). On the other hand stent implantation has shown excellent short-term results in both children and in adults with native coarctation (8).…”

“…Surgery especially remains the treatment of choice in neonates (8). On the other hand stent implantation has shown excellent short-term results in both children and in adults with native coarctation (8).…”

Incidental Finding of Interrupted Aortic Arch in an Asymptomatic Adult: To Treat or Not to Treat?

“…In the current era, advances in the percutaneous treatment of such defect have also been made and described [6,7]. However, while clinical, both short and long-term, benefits of surgical treatment in the infant population are well documented, great debate and inconsistency of results are reported for the adult population.…”