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Two decades of aortic coarctation treatment in children; evaluating techniques

E J Dijkema1, L Dik2, J M P Breur2

  • 1Department of Pediatric Cardiology, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands. ellesdijkema@gmail.com.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|November 11, 2020
PubMed

Insights

Surgical repair is preferred for complex pediatric aortic coarctation, while catheter interventions suit simpler cases. Reintervention is common, especially after catheter procedures and early surgery, with one-fifth of patients developing hypertension.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Surgical Innovation

Background:

  • Aortic coarctation is a critical congenital heart defect requiring timely intervention.
  • Treatment strategies have evolved, necessitating an evaluation of long-term outcomes.
  • Understanding treatment trends and their impact on morbidity is crucial for pediatric cardiac care.

Purpose of the Study:

  • To analyze the evolution of treatment techniques for pediatric aortic coarctation.
  • To assess the long-term morbidity associated with different treatment modalities.
  • To identify factors influencing reintervention rates and long-term outcomes.

Main Methods:

  • Retrospective cohort study of 206 patients with native aortic coarctation.
  • Inclusion of patients with a minimum of 7 years of follow-up.
  • Categorization into three eras based on the year of primary intervention to track changes over time.

Main Results:

  • Surgical repair, particularly with simultaneous aortic arch repair, increased in recent eras.
  • Reintervention rates were significantly higher for catheter-based interventions (HR 1.8) and surgery under 3 months of age (HR 2.1).
  • Hypertension was observed in 20% of patients, highlighting a significant long-term morbidity.

Conclusions:

  • Current practice favors surgical intervention for complex aortic coarctation with associated defects.
  • Catheter-based interventions are increasingly used for less complex cases.
  • High reintervention rates, particularly in specific patient groups, underscore the need for ongoing monitoring and potential improvements in treatment strategies.
Abstract

Keywords:
Cardiothoracic surgeryCoarctationCongenital heart diseaseEndovascular stent placement

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