Repair of coarctation of the aorta in infancy: comparison of surgical and balloon angioplasty.
Surgical repair of coarctation of the aorta in infancy has recently been challenged by some investigators who suggest that balloon angioplasty results in a lower mortality rate and similar risk of restenosis. Over a 44-month period, 37 consecutive infants with a mean age of 33 days (median, 15 days; range, 1 to 200 days) and mean and median weight of 3.7 kg (range, 2.4 to 5.4 kg) underwent surgical repair of coarctation of the aorta with either an end-to-end anastomosis (24 patients) or subclavian flap angioplasty (13 patients). There were no operative deaths (95% confidence interval, 0% to 10%). Four patients died late (> 30 days) after surgery (11%). Four patients (11%) (95% confidence interval, 3% to 25%) had residual gradients greater than 20 mm Hg. A review of the recent literature on treatment of native coarctation in infants with surgical repair (18 reports, 1189 patients) and balloon angioplasty (8 reports, 57 patients) reveals a similar early mortality rate but a much higher rate of recoarctation in infants who were treated with balloon dilation (57%) as compared with those who underwent surgical repair (14%). Because of the incidence of restenosis, balloon dilation as compared with surgical repair does not yet offer an improved outcome for native coarctation of the aorta in infancy.
Johnson
M C
MC
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Canter
C E
CE
Strauss
A W
AW
Spray
T L
TL
D000015:Abnormalities, Multiple / Q000401:mortality; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D001011:Aorta / Q000601:surgery; D001017:Aortic Coarctation / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome