Advancing treatment strategies for coarctation of the aorta: a comprehensive single-centre experience

Coarctation of the aorta accounts for approximately 6-8% of CHDs, typically manifesting as narrowing of the proximal thoracic aorta. Clinical and haemodynamic effects vary depending on the severity and associated anomalies. We aimed to compare the outcomes of surgical versus percutaneous interventions in patients with coarctation of the aorta and to identify factors influencing the choice of treatment strategy.

We retrospectively analysed the medical records of 120 patients diagnosed and treated for coarctation of the aorta at Ankara University Faculty of Medicine, Department of Pediatric Cardiology over a 12-year period. Patients were grouped by age (0-4 months and >4 months). Clinical and echocardiographic data were reviewed. Treatment selection was based on American Heart Association 2011 guidelines, considering age, weight, and anatomy. Surgical repair was preferred in infants <4 months; balloon angioplasty or stent implantation was used in older patients. Procedural success and complications were assessed.

A total of 62% were male, the median age at diagnosis was 1.1 months, and 67% were diagnosed before 4 months of age. The most common symptom was a cardiac murmur (62.5%). Initially, balloon angioplasty was performed in 50%, surgical repair in 45%, and stent implantation in 5%. The acute success rate was 98.3%. Complications occurred in 13.3%, including thrombosis (7.5%) and aneurysm (2.5%). Recoarctation developed in 43% and was significantly higher after balloon angioplasty compared to surgery (55% vs. 29.6%, p = 0.004), and in patients <4 months (52.2% vs. 25.5%, p = 0.014). Management strategies typically included surgical repair in infants <4 months, balloon angioplasty in older children, and stenting in those ≥25 kg, while treatment was ultimately individualised.

Recoarctation was the most frequent complication, especially among infants under four months and after balloon angioplasty. Surgical repair was associated with a lower risk of recoarctation in early infancy. Percutaneous stent implantation for coarctation is an effective and safe procedure, but it is limited by the patient's weight. Individualised treatment based on age, anatomy, and clinical status is essential to optimise outcomes.