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Surgical versus balloon therapy for aortic coarctation in infants < or = 3 months old
P S Rao1, P S Chopra, R Koscik
1Department of Pediatrics, University of Wisconsin Medical School, Madison.
Insights
Balloon angioplasty and surgical correction show similar outcomes for infant aortic coarctation. However, balloon angioplasty offers lower morbidity and complication rates, suggesting it as a viable alternative treatment.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Aortic coarctation is a critical congenital heart defect.
- Treatment controversies exist for balloon angioplasty versus surgery in young infants.
Purpose of the Study:
- To compare the efficacy and safety of balloon angioplasty and surgical correction for native aortic coarctation in infants under 3 months old.
Main Methods:
- Retrospective analysis of 29 infants (< or = 3 months) with aortic coarctation.
- Comparison between 14 infants undergoing surgery and 15 undergoing balloon angioplasty.
- Patient groups were similar in age, weight, and associated defects.
Main Results:
- Similar mortality rates (operative and late) and gradient relief in both groups.
- Shorter hospital stay, intubation, and ventilation durations for balloon angioplasty.
- Significantly lower complication rates (0.27 events/patient) with balloon angioplasty versus surgery (0.86 events/patient).
Conclusions:
- Balloon angioplasty and surgical correction yield comparable results for aortic coarctation relief and reintervention rates.
- Balloon angioplasty demonstrates lower morbidity and complication rates.
- Balloon angioplasty is a potential alternative to surgery for symptomatic aortic coarctation in young infants.
Objectives:
This study compared the efficacy and safety of balloon angioplasty with surgical correction of native aortic coarctation in infants < or = 3 months old.
Background:
There is a controversy with regard to the role of balloon angioplasty in the treatment of aortic coarctation, especially in young infants.
Methods:
Data from 29 infants < or = 3 months old undergoing therapy for aortic coarctation during the decade ending 1992 were analyzed. Fourteen infants underwent surgery, and 15 had balloon angioplasty. The sole criterion for allotment to the balloon group was the availability of an interventional cardiologist at the time of presentation of the infant.
Results:
The surgical and balloon groups were comparable (p > 0.1) with regard to age (27 +/- 35 [mean +/- SD] vs. 29 +/- 27 days), weight (3.5 +/- 0.9 vs. 3.8 +/- 1.0 kg) and prevalence (7 of 14 vs. 8 of 15) and type of associated defects. Operative (1 of 14 vs. 1 of 15) and late (3 of 13 vs. 3 of 14) mortality, immediate gradient relief (36 +/- 25 to 10 +/- 9 mm Hg vs. 41 +/- 14 to 6 +/- 6 mm Hg) and follow-up gradient (27 +/- 27 vs. 24 +/- 19 mm Hg) were similar (p > 0.1). Infants with a gradient > 20 mm Hg at follow-up (6 of 13 vs. 7 of 14) and need for reintervention (6 of 13 vs. 7 of 14) were also similar (p > 0.1) in both groups. Duration of hospital stay during the first intervention was higher (p < 0.05) in the surgical (32 +/- 37 days) than the balloon (7 +/- 6 days) group. Similarly, duration of endotracheal intubation and mechanical ventilation was longer (p < 0.05) in the surgical (12 +/- 16 days) than the balloon (2 +/- 3 days) group. Complications after surgical intervention (0.86 events/patient) were higher (p < 0.01) than those seen after balloon angioplasty (0.27 events/patient). However, the lack of significant differences observed for mortality rates and residual gradients may be due to low statistical power to detect differences (16% to 49%), implying that this may be due to either actual lack of statistical difference or small sample size.
Conclusions:
The data indicate that the degree of relief from aortic coarctation and the frequency with which reintervention is needed are similar in both groups. However, the morbidity and complication rates are lower with balloon than with surgical therapy. These data suggest that balloon angioplasty may be an acceptable alternative to surgical correction in the treatment of symptomatic aortic coarctation in infants < or = 3 months old.