What Is the Appropriate Treatment Modality for Coarctation Repair?

Background: Coarctation of aorta (CoA) is complex disease with important long-term morbidity and mortality. The aim of this study was to analyze different treatment modalities (surgery vs. stenting) in regards to survival benefits and effectiveness of treatment.

Methods and patients: Between 2005 and 2012, 97 patients (pts) with simple CoA underwent either surgical repair (group A – 61 pts [63%]) or stenting (group B – 36 pts [37%]). According to institutional protocol all newborns and infants (58 pts) underwent primary surgery but 8 pts who needed temporary stenting to relief afterload and improve the left ventricular function. Based on underlying anatomy the pts between 1 and 10 years of age were treated either by surgery (46%) or by stenting (54%). All pts > 10 years were stented.

Result: There was no early or late death with the mean follow-up 2.2 ± 1.9 years. Both methods equally effectively eliminated blood pressure gradient between arm and leg (A =– 0.8 ± 11.6 mm Hg vs. B =– 0.3 ± 10.0 mm Hg [p= 0.6]). Freedom from reintervention was significantly favorable (p= 0.0005) for group A (94.7 ± 3.6%) in comparison with group B (52.4 ± 10.6%). During observation period, there were no clinically apparent neurological problems. All patients are doing well, and growth is adequate.

Conclusions: Both methods are equally safe and effective regarding release of gradient. However the appropriate surgical treatment, performed during the first year of life provides the most physiological palliation of CoA with minimal needs for reinterventions. In newborns temporary stenting, followed by surgery, is excellent method to decompress the left heart. Primary stenting should be reserved only for older patients if surgery is risky or physiological repair without artificial material would be technically difficult.