title: Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium).
abstract: OBJECTIVE
  The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation acutely and at follow-up.
  
  
  BACKGROUND
  Controversy surrounds the optimal treatment for native coarctation of the aorta. This is the first multicenter study evaluating acute and follow-up outcomes of these 3 treatment options in children weighing >10 kg.
  
  
  METHODS
  This is a multicenter observational study. Baseline, acute, short-term (3 to 18 months), and intermediate (>18 months) follow-up hemodynamic, imaging data, and complications were recorded.
  
  
  RESULTS
  Between June 2002 and July 2009, 350 patients from 36 institutions were enrolled: 217 underwent stent, 61 underwent BA, and 72 underwent surgery. All 3 arms showed significant improvement acutely and at follow-up in resting systolic blood pressure and upper to lower extremity systolic blood pressure gradient (ULG). Stent was superior to BA in achieving lower ULG acutely. Surgery and stent were superior to BA at short-term follow-up in achieving lower ULG. Stent patients had shorter hospitalization than surgical patients (2.4 vs. 6.4 days; p < 0.001) and fewer complications than surgical and BA patients (2.3%, 8.1%, and 9.8%; p < 0.001). The BA patients were more likely to encounter aortic wall injury, both acutely and at follow-up (p < 0.001).
  
  
  CONCLUSIONS
  Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution.
authors.affiliation: Children's Hospital of Michigan, Detroit, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Forbes
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Kim
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Turner
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: Zahid
authors.initials: Z
authors.lastname: Amin
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Hijazi
authors.forename: Abdolrahim
authors.initials: A
authors.lastname: Ghasemi
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.forename: David
authors.initials: D
authors.lastname: Nykanen
authors.forename: Evan
authors.initials: E
authors.lastname: Zahn
authors.forename: Collin
authors.initials: C
authors.lastname: Cowley
authors.forename: Mark
authors.initials: M
authors.lastname: Hoyer
authors.forename: David
authors.initials: D
authors.lastname: Waight
authors.forename: Daniel
authors.initials: D
authors.lastname: Gruenstein
authors.forename: Alex
authors.initials: A
authors.lastname: Javois
authors.forename: Susan
authors.initials: S
authors.lastname: Foerster
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kreutzer
authors.forename: Nancy
authors.initials: N
authors.lastname: Sullivan
authors.forename: Asra
authors.initials: A
authors.lastname: Khan
authors.forename: Carl
authors.initials: C
authors.lastname: Owada
authors.forename: Donald
authors.initials: D
authors.lastname: Hagler
authors.forename: Scott
authors.initials: S
authors.lastname: Lim
authors.forename: Joshua
authors.initials: J
authors.lastname: Canter
authors.forename: Thomas
authors.initials: T
authors.lastname: Zellers
mesh_terms: D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult