Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery
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 literatur...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Annals of Pediatric Cardiology |
| Subjects: | |
| Online Access: | http://www.annalspc.com/article.asp?issn=0974-2069;year=2018;volume=11;issue=3;spage=261;epage=266;aulast=Sen |
| _version_ | 1828424745584951296 |
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| author | Supratim Sen Sandeep Garg Suresh G Rao Snehal Kulkarni |
| author_facet | Supratim Sen Sandeep Garg Suresh G Rao Snehal Kulkarni |
| author_sort | Supratim Sen |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T16:22:21Z |
| format | Article |
| id | doaj.art-177236f66a2a407f8f3ecfb300d3300e |
| institution | Directory Open Access Journal |
| issn | 0974-2069 |
| language | English |
| last_indexed | 2024-12-10T16:22:21Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Pediatric Cardiology |
| spelling | doaj.art-177236f66a2a407f8f3ecfb300d3300e2022-12-22T01:41:46ZengWolters Kluwer Medknow PublicationsAnnals of Pediatric Cardiology0974-20692018-01-0111326126610.4103/apc.APC_165_17Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgerySupratim SenSandeep GargSuresh G RaoSnehal KulkarniBackground: 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.http://www.annalspc.com/article.asp?issn=0974-2069;year=2018;volume=11;issue=3;spage=261;epage=266;aulast=SenBalloon angioplastycoarctation of the aortasurgical coarctation repair |
| spellingShingle | Supratim Sen Sandeep Garg Suresh G Rao Snehal Kulkarni Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery Annals of Pediatric Cardiology Balloon angioplasty coarctation of the aorta surgical coarctation repair |
| title | Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery |
| title_full | Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery |
| title_fullStr | Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery |
| title_full_unstemmed | Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery |
| title_short | Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery |
| title_sort | native aortic coarctation in neonates and infants immediate and midterm outcomes with balloon angioplasty and surgery |
| topic | Balloon angioplasty coarctation of the aorta surgical coarctation repair |
| url | http://www.annalspc.com/article.asp?issn=0974-2069;year=2018;volume=11;issue=3;spage=261;epage=266;aulast=Sen |
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