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Stent placement versus surgery for coarctation of the thoracic aorta
Laryssa Maria Siqueira Pádua1, Lucas Cezar Garcia, Claudio Jose Rubira
1Department of EvidenceBasedHealthActions,MariliaMedical School, São Paulo, Brazil. laryssa.siqueira@gmail.com
Insights
Current evidence is insufficient to determine the best treatment for coarctation of the aorta (CoA). More randomized trials are needed to compare open surgery with stent placement for CoA.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) is a congenital heart defect affecting 0.3-0.4% of live births.
- Surgical repair has been the standard treatment, with balloon angioplasty and endovascular stents emerging as alternatives.
- Complications like re-coarctation and aneurysm remain concerns for all treatment modalities.
Purpose of the Study:
- To compare the effectiveness and safety of endovascular stent placement versus open surgery for treating thoracic coarctation of the aorta.
Main Methods:
- A systematic review of randomized or quasi-randomized controlled trials was conducted.
- Searches were performed across multiple databases up to September 2011.
- Studies comparing open surgery with stent placement for coarctation of the aorta were included.
Main Results:
- Five studies were initially selected for full-text analysis.
- All selected studies were excluded due to a lack of direct comparison between stent placement and open surgery.
- No eligible studies were found that met the inclusion criteria.
Conclusions:
- There is insufficient evidence to establish the optimal treatment for coarctation of the aorta.
- High-quality randomized controlled trials are necessary to evaluate outcomes, sample size, and long-term follow-up.
- Future research should focus on robust methodologies to guide clinical decision-making.
Background:
Coarctation of the aorta (CoA) accounts for 5% to 7% of congenital heart disease, with an incidence of 0.3 to 0.4 per 1000 live births. Surgery was the only choice of therapy for CoA until 1982 when balloon angioplasty became an available alternative for its treatment. Re-coarctation, aneurysm and aortic dissection remain the disadvantages of both treatments. To avoid those disadvantages, in 1990 endovascular stents were introduced for native coarctation and re-coarctation and since then they have become an alternative approach to surgical repair. The best approach to treat the CoA, whether open surgery or by stent placement, is not clear.
Objectives:
To analyze the effectiveness and safety of stent placement compared with open surgery in patients with coarctation of the thoracic aorta.
Search Methods:
The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched September 2011) and CENTRAL (2011, Issue 3). We also searched MEDLINE, EMBASE, CINAHL, AMED, Web of Science and LILACS (last searched in September 2011). We evaluated the located references and applied the inclusion criteria to selected studies. There was no restriction on language.
Selection Criteria:
Randomized or quasi-randomized controlled clinical trials that compared patients with CoA undergoing open surgery or stent placement.
Data Collection And Analysis:
The review authors independently assessed the studies identified for eligibility for inclusion. We excluded studies after a consensus meeting.
Main Results:
All identified studies were screened and had the selection criteria applied to the title and abstract. In total, we selected five studies for full-text analysis. After detailed evaluation, we excluded all studies because there was no comparison between stent placement and open surgery.
Authors' Conclusions:
There is insufficient evidence with regards to the best treatment for coarctation of the thoracic aorta. This review suggests a need to perform a randomized controlled clinical trial with emphasis on the allocation method, evaluation of primary outcomes, size and quality of the sample, and long-term follow-up.
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