title: Coarctation of the aorta - the current state of surgical and transcatheter therapies.
abstract: Aortic coarctation represents a distinct anatomic obstruction as blood moves from the ascending to the descending aorta and can present in a range of ages from infancy to adulthood. While it is often an isolated and discrete narrowing, it can also be seen in the more extreme scenario of severe arch hypoplasia as seen in the hypoplastic left heart syndrome or in conjunction with numerous other congenital heart defects. Since the first description of an anatomic surgical repair over sixty years ago, an evolution of both surgical and transcatheter therapies has occurred allowing clinicians to manage and treat this disease with excellent results and low morbidity and mortality. This review focuses on the current state of both transcatheter and surgical therapies, paying special attention to recent data on long-term follow-up of both approaches. Further, current thoughts will be explored about future therapeutic options that attempt to improve upon historical long-term outcomes.
authors.affiliation: Children’s Hospital Heart Center, Department of Pediatrics, University of Virginia, USA. jvergales@virginia.edu
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Vergales
authors.forename: James J
authors.initials: JJ
authors.lastname: Gangemi
authors.forename: Karen S
authors.initials: KS
authors.lastname: Rhueban
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome; D008134:Long-Term Care; D015607:Stents; D013524:Surgical Flaps
references.citation: J Am Coll Cardiol. 1996 Feb;27(2):462-70
references.pmid: 8557921
references.citation: J Am Coll Cardiol. 1989 Sep;14(3):734-41
references.pmid: 2768722
references.citation: Am J Cardiol. 1963 Jun;11:714-25
references.pmid: 13988650
references.citation: J Invasive Cardiol. 2003 Apr;15(4):202-8
references.pmid: 12668848
references.citation: Am J Cardiol. 1986 Jul 1;58(1):178-80
references.pmid: 2942028
references.citation: Circulation. 1990 Mar;81(3):996-1004
references.pmid: 2306843
references.citation: Ann Thorac Surg. 2008 Sep;86(3):869-74; discussion 869-74
references.pmid: 18721575
references.citation: J Thorac Cardiovasc Surg. 1991 Oct;102(4):596-601
references.pmid: 1921436
references.citation: Circulation. 2005 Feb 8;111(5):622-8
references.pmid: 15699283
references.citation: Eur Heart J. 2008 Aug;29(16):2042-8
references.pmid: 18550553
references.citation: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004;7:3-10
references.pmid: 15283346
references.citation: Am J Cardiol. 2010 Apr 15;105(8):1176-80
references.pmid: 20381673
references.citation: Pediatr Cardiol. 2009 May;30(4):414-8
references.pmid: 19184170
references.citation: Circulation. 1986 Sep;74(3 Pt 2):I25-31
references.pmid: 3527470
references.citation: Circulation. 2005 Jun 28;111(25):3453-6
references.pmid: 15956126
references.citation: Br Heart J. 1970 Sep;32(5):633-40
references.pmid: 5470045
references.citation: Circulation. 2010 Sep 14;122(11 Suppl):S81-4
references.pmid: 20837930
references.citation: Eur J Cardiothorac Surg. 2007 Apr;31(4):649-53
references.pmid: 17276693
references.citation: J Interv Cardiol. 1993 Jun;6(2):113-23
references.pmid: 10150998
references.citation: J Am Coll Cardiol. 2005 Jun 7;45(11):1844-8
references.pmid: 15936617
references.citation: Ann Thorac Surg. 2008 Apr;85(4):1397-401; discussion 1401-2
references.pmid: 18355534
references.citation: Am Heart J. 1990 Jun;119(6):1421-3
references.pmid: 2141223
references.citation: Vasc Surg. 1977 Mar-Apr;11(2):63-7
references.pmid: 308284
references.citation: Br Heart J. 1983 Aug;50(2):176-81
references.pmid: 6882605
references.citation: Circulation. 2007 Oct 9;116(15):1736-54
references.pmid: 17446442
references.citation: Catheter Cardiovasc Interv. 2010 Oct 1;76(4):553-63
references.pmid: 20882661
references.citation: Cardiol Young. 2008 Feb;18(1):79-88
references.pmid: 18205970
references.citation: Circulation. 1981 Jul;64(1):164-8
references.pmid: 7237715
references.citation: Circulation. 1995 Nov 1;92(9 Suppl):II132-6
references.pmid: 7586396
references.citation: Circulation. 1993 Mar;87(3):793-9
references.pmid: 8443900
references.citation: AJR Am J Roentgenol. 2006 Sep;187(3):W302-12
references.pmid: 16928909
references.citation: J Thorac Cardiovasc Surg. 2011 Nov;142(5):1130-6, 1136.e1
references.pmid: 21741056
references.citation: Am Heart J. 1995 Jun;129(6):1220-1
references.pmid: 7754958
references.citation: Am Heart J. 1982 Jan;103(1):131-2
references.pmid: 6459728
references.citation: J Am Coll Cardiol. 1986 Dec;8(6):1406-11
references.pmid: 2946743
references.citation: Am Heart J. 1993 Dec;126(6):1380-4
references.pmid: 8249796
references.citation: Ann Thorac Surg. 2001 May;71(5):1530-6
references.pmid: 11383795
references.citation: Ann Thorac Surg. 2009 Dec;88(6):1923-30; discussion 1930-1
references.pmid: 19932264
references.citation: Am J Med. 2002 May;112(7):590-2
references.pmid: 12015258
references.citation: Catheter Cardiovasc Interv. 2008 Jan 1;71(1):120-6
references.pmid: 18098214
references.citation: Ann Surg. 1951 Oct;134(4):753-68
references.pmid: 14878385
references.citation: Ann Thorac Surg. 1995 Jun;59(6):1491-4
references.pmid: 7539608
references.citation: J Thorac Cardiovasc Surg. 1980 Apr;79(4):603-8
references.pmid: 6987464
references.citation: Thorac Cardiovasc Surg. 1983 Jun;31(3):160-2
references.pmid: 6192523
references.citation: Ann Thorac Surg. 2003 Oct;76(4):1090-3
references.pmid: 14529992
references.citation: J Thorac Cardiovasc Surg. 2003 Aug;126(2):521-8
references.pmid: 12928653
references.citation: J Am Coll Cardiol. 2004 Mar 17;43(6):1062-7
references.pmid: 15028367
references.citation: Ann Thorac Surg. 1977 Mar;23(3):261-3
references.pmid: 849035
references.citation: Circulation. 1982 Dec;66(6):1280-6
references.pmid: 6216025
references.citation: Am J Cardiol. 1990 Mar 15;65(11):790-2
references.pmid: 2316462
references.citation: Cathet Cardiovasc Diagn. 1984;10(1):17-25
references.pmid: 6713531
references.citation: Ann Thorac Surg. 1999 May;67(5):1376-9
references.pmid: 10355415
references.citation: J Am Coll Cardiol. 2006 Apr 4;47(7):1457-63
references.pmid: 16580536
references.citation: J Cardiovasc Surg (Torino). 1978 Jan-Feb;19(1):49-54
references.pmid: 627592
references.citation: Am J Cardiol. 1983 May 15;51(9):1481-8
references.pmid: 6846181
references.citation: Circulation. 1983 Jul;68(1):109-16
references.pmid: 6221828
references.citation: J Thorac Cardiovasc Surg. 1994 Jan;107(1):87-95
references.pmid: 8283924
references.citation: J Magn Reson Imaging. 2003 Feb;17(2):177-83
references.pmid: 12541224
references.citation: J Am Coll Cardiol. 1993 Nov 1;22(5):1515-21
references.pmid: 8227813
references.citation: Circulation. 2000 Jul 25;102(4):399-404
references.pmid: 10908211
references.citation: Catheter Cardiovasc Interv. 2010 Nov 15;76(6):852-9
references.pmid: 20506213
references.citation: J Thorac Cardiovasc Surg. 1966 Apr;51(4):532-3
references.pmid: 5931951
references.citation: J Am Coll Cardiol. 2011 Dec 13;58(25):2664-74
references.pmid: 22152954
references.citation: Ann Thorac Surg. 2002 Nov;74(5):1631-4
references.pmid: 12440621
references.citation: Catheter Cardiovasc Interv. 2007 Aug 1;70(2):276-85
references.pmid: 17630670
references.citation: Am J Cardiol. 1985 Feb 15;55(5):612
references.pmid: 3969920
references.citation: Circulation. 1969 May;39(5 Suppl 1):I173-84
references.pmid: 5792971
references.citation: Pediatr Cardiol. 2005 Mar-Apr;26(2):176-89
references.pmid: 15868319
references.citation: Thorax. 1961 Dec;16:338-45
references.pmid: 13926829
references.citation: Heart. 2006 Jan;92(1):90-4
references.pmid: 15845612
references.citation: Radiology. 1989 Nov;173(2):499-502
references.pmid: 2798882
references.citation: Catheter Cardiovasc Interv. 2007 Nov 15;70(6):881-6
references.pmid: 17932886
references.citation: Pediatr Cardiol. 1991 Jan;12(1):1-5
references.pmid: 1997976
references.citation: Pediatr Cardiol. 2011 Feb;32(2):202-5
references.pmid: 21188374
references.citation: J Am Coll Cardiol. 2011 Aug 16;58(8):868-76
references.pmid: 21835324
references.citation: J Thorac Cardiovasc Surg. 2009 Sep;138(3):547-52
references.pmid: 19698833
references.citation: Ann Thorac Surg. 2006 Apr;81(4):1420-8
references.pmid: 16564285
references.citation: Cardiology. 2009;112(1):36-41
references.pmid: 18580057
references.citation: J Am Coll Cardiol. 1996 Dec;28(7):1818-26
references.pmid: 8962572
references.citation: JACC Cardiovasc Interv. 2009 Sep;2(9):877-83
references.pmid: 19778777
references.citation: Ann Thorac Surg. 2005 Nov;80(5):1659-64; discussion 1664-5
references.pmid: 16242435
references.citation: Circ Cardiovasc Interv. 2009 Jun;2(3):255-60
references.pmid: 20031723
references.citation: Am J Cardiol. 1972 Oct;30(5):514-25
references.pmid: 4672503
references.citation: Ann Thorac Surg. 2006 Jul;82(1):158-63
references.pmid: 16798207
references.citation: Catheter Cardiovasc Interv. 2006 May;67(5):671-3
references.pmid: 16575923
references.citation: Cardiol Young. 2007 Jun;17(3):307-18
references.pmid: 17319978
references.citation: Catheter Cardiovasc Interv. 2007 Oct 1;70(4):569-77
references.pmid: 17896405
references.citation: Circulation. 1986 Jan;73(1):82-8
references.pmid: 3940672
references.citation: Ann Thorac Surg. 2005 Oct;80(4):1453-9
references.pmid: 16181886
references.citation: J Pediatr Surg. 1978 Jun;13(3):264-8
references.pmid: 671191
references.citation: Am Heart J. 2007 Jul;154(1):186-92
references.pmid: 17584575
references.citation: J Thorac Cardiovasc Surg. 2008 Nov;136(5):1229-36
references.pmid: 19026808