Intraluminal aortoplasty vs. surgical aortic resection in congenital aortic coarctation. A clinical random study in pediatric patients
Martha Hernández-González1, Sergio Solorio, Ignacio Conde-Carmona
1Servicio de Cardiopatías Congénitas, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico. echoca@yahoo.com.mx
Insights
Surgical aortic resection is more effective than intraluminal aortoplasty for treating congenital aortic coarctation, showing lower rates of re-coarctation and persistent hypertension, despite more serious complications.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Congenital aortic coarctation requires effective treatment to prevent long-term complications.
- Comparing intraluminal aortoplasty and surgical resection is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare intraluminal aortoplasty without stenting versus surgical aortic resection for congenital aortic coarctation.
- To evaluate immediate and long-term results, including re-coarctation, aneurysm, and pressure gradients.
Main Methods:
- A randomized, multicenter clinical study in pediatric patients with congenital aortic coarctation.
- Evaluation of trans-coarctation pressure gradient pre- and post-treatment.
- Assessment of re-coarctation, aneurysm, morbidity, mortality, and complications.
Main Results:
- Both intraluminal angioplasty and surgical resection effectively reduced pressure gradients.
- Surgical resection showed significantly lower rates of re-coarctation (21% vs. 50%) and persistent hypertension (19% vs. 49%).
- Complications from surgery were more severe but not statistically significant compared to angioplasty.
Conclusions:
- Surgical aortic resection demonstrates superior long-term efficacy in managing congenital aortic coarctation.
- While angioplasty has fewer severe complications, surgical resection offers better control of re-coarctation and hypertension.
- Further research may clarify the risk-benefit balance for each procedure.
Background:
Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated.
Methods:
A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05.
Results:
There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant.
Conclusions:
Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.
