title: Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood.
abstract: OBJECTIVE
  The aim of the study was to analyze immediate results, rate of complications and re-interventions during medium-term outcome in pediatric patients with native or recurrent aortic coarctation. We focused on an age-related therapeutic approach comparing surgical and trans-catheter treatment.
  
  
  METHODS
  This is a retrospective, single-centre, clinical observational trial including 91 consecutive patients (age: 1 day-18 years) treated for native coarctation in 67 and recurrent aortic coarctation in 24 patients. Surgical treatment was performed in 56, trans-catheter treatment with balloon dilatation in 17, and by stent implantation in 18 patients. According to the age groups, we treated 48 children in group A (<6 months of age), 16 in group B (6 months-6 years), and 27 in group C (>6 years). A total of 41 patients in group A were operated (85%), patients in group B received either surgical or trans-catheter treatment (50% vs 50%), and 16 patients in group C were treated by stent implantation (62%).
  
  
  RESULTS
  Immediate results were excellent with a significant release of pressure gradient in all three age groups (64.7% in group A, 69.1% in group B, and 63.3% in group C). Complication rate and re-intervention rate (surgical and interventional) both were [corrected] comparable between the three age groups (complications: group A 8.3%, group B 6.3%, and group C 3.7%, [corrected] re-interventions: group A 16.6%, group B 18.8%, and group C 14.8%). [corrected] Midterm outcome after a median follow-up period of 17.5 months was satisfactory with a re-intervention-free survival after 17.5 months of 83.4%, 81.2%, and 81.5% in group A, group B, and group C, respectively.
  
  
  CONCLUSIONS
  The current strategy of an age-related therapy for native and recurrent aortic coarctation in our institution is surgery in infants <6 months (group A), either surgery or balloon dilatation in younger patients <6 years (group B), while in older children >6 years of age (group C) the trans-catheter treatment with stent implantation is an excellent alternative to surgery. Balloon dilatations showed limited results with an overall re-intervention rate of 53% and, therefore, should mainly be performed as a rescue procedure or in recurrent aortic coarctation in neonates.
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Seraina
authors.initials: S
authors.lastname: Früh
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.forename: Hitendu
authors.initials: H
authors.lastname: Dave
authors.forename: René
authors.initials: R
authors.lastname: Prêtre
authors.forename: Oliver
authors.initials: O
authors.lastname: Kretschmar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D001017:Aortic Coarctation / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome