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Ashfaq A, Bedzra E, Rajab KT, Bonnell LN, Muralidaran A, Bleiweis M, Morales DLS, Habib RH, Jacobs J, Quintessenza JA. Contemporary Practice of Native Coarctation in Children Greater Than One Year of Age: A Society of Thoracic Surgeons Analysis. World J Pediatr Congenit Heart Surg 2025:21501351241311276. [PMID: 39911131 DOI: 10.1177/21501351241311276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2025]
Abstract
OBJECTIVE Limited data exist on surgical repairs for native coarctation of the aorta (Native-CoA) after year-one of life. We sought to establish surgical outcomes benchmark of older Native-CoA repair patients. METHODS All patients greater than one year of age who underwent off-pump Native-CoA repair were identified from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) between January 1998 and December 2022. RESULTS A total of 2,898 patients older than one year (mean age: 6.1 years; mean weight: 23.7 kg) underwent Native-CoA repair through left thoracotomy at 131 STS-CHSD centers. Vascular syndromes including Turners, Williams, and Alagille, were relatively rare at 1.8%. The most common procedures were extended end-to-end (1,309/2898, 45.2%) end-to-end 1,107/2898, (38.2%), and patch aortoplasty ((239/2898, 8.2%). From 1998 to 2018, there was an overall increase in the number of patients (14 vs 156), explained largely by the increased number of hospitals (4 vs 70). However, after 2018, case counts declined by nearly 50%. Operative mortality was rare (n = 3). An average of 1.2 complications per patient (438 total) occurred in 365/2898 (12.6%) patients. The most common complications included chylothorax (101/2898, 3.5%), unplanned 30-day readmission (28/1917, 1.5%), and arrhythmia requiring drug therapy (17/1917, 0.9%). Median length of hospital stay was four days, with hospital stay >6 days in 248 patients (14.8%). CONCLUSIONS Frequency of off-pump Native-CoA repairs (age >1 year) is decreasing despite no notable change in total participating hospitals and case counts. This is likely due to increased percutaneous interventions despite very low documented mortality and morbidity of off-pump surgical repairs.
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Affiliation(s)
- Awais Ashfaq
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Edo Bedzra
- Heart Institute, Children's Mercy Hospital, Kansas, MO, USA
| | - Konrad T Rajab
- Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Levi N Bonnell
- Society of Thoracic Surgeons Research and Analytic Center, Chicago, IL, USA
| | - Ashok Muralidaran
- Pediatric Cardiothoracic Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Mark Bleiweis
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - David L S Morales
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert H Habib
- Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey Jacobs
- Department of Surgery, University of Florida, Gainesville, FL, USA
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Oropeza BP, Adams JR, Furth ME, Chessa J, Boland T. Bioprinting of Decellularized Porcine Cardiac Tissue for Large-Scale Aortic Models. Front Bioeng Biotechnol 2022; 10:855186. [PMID: 35360395 PMCID: PMC8960451 DOI: 10.3389/fbioe.2022.855186] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Bioprinting is an emerging technique used to layer extrudable materials and cells into simple constructs to engineer tissue or arrive at in vitro organ models. Although many examples of bioprinted tissues exist, many lack the biochemical complexity found in the native extracellular matrix. Therefore, the resulting tissues may be less competent than native tissues—this can be especially problematic for tissues that need strong mechanical properties, such as cardiac or those found in the great vessels. Decellularization of native tissues combined with processing for bioprinting may improve the cellular environment for proliferation, biochemical signaling, and improved mechanical characteristics for better outcomes. Whole porcine hearts were decellularized using a series of detergents, followed by lyophilization and mechanical grinding in order to produce a fine powder. Temperature-controlled enzymatic digestion was done to allow for the resuspension of the decellularized extracellular matrix into a pre-gel solution. Using a commercial extrusion bioprinter with a temperature-controlled printhead, a 1:1 scale model of a human ascending aorta and dog bone shaped structures were printed into a reservoir of alginate and xanthium gum then allowed to crosslink at 37C. The bioengineered aortic construct was monitored for cell adhesion, survival, and proliferation through fluorescent microscopy. The dog bone structure was subjected to tensile mechanical testing in order to determine structural and mechanical patterns for comparison to native tissue structures. The stability of the engineered structure was maintained throughout the printing process, allowing for a final structure that upheld the dimensions of the original Computer-Aided Design model. The decellularized ECM (Ē = 920 kPa) exhibited almost three times greater elasticity than the porcine cardiac tissue (Ē = 330 kPa). Similarly, the porcine cardiac tissue displayed two times the deformation than that of the printed decellularized ECM. Cell proliferation and attachment were observed during the in vitro cell survivability assessment of human aortic smooth muscle cells within the extracellular matrix, along with no morphological abnormalities to the cell structure. These observations allow us to report the ability to bioprint mechanically stable, cell-laden structures that serve as a bridge in the current knowledge gap, which could lead to future work involving complex, large-scale tissue models.
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Affiliation(s)
- Beu P. Oropeza
- Biomedical Device, Delivery and Diagnostic Laboratory, Metallurgical, Materials and Biomedical Engineering Department, The University of Texas at El Paso, El Paso, TX, United States
| | - Jason R. Adams
- Aerospace and Mechanical Engineering, The University of Texas at El Paso, El Paso, TX, United States
| | - Michael E. Furth
- Biomedical Device, Delivery and Diagnostic Laboratory, Metallurgical, Materials and Biomedical Engineering Department, The University of Texas at El Paso, El Paso, TX, United States
| | - Jack Chessa
- Aerospace and Mechanical Engineering, The University of Texas at El Paso, El Paso, TX, United States
| | - Thomas Boland
- Biomedical Device, Delivery and Diagnostic Laboratory, Metallurgical, Materials and Biomedical Engineering Department, The University of Texas at El Paso, El Paso, TX, United States
- *Correspondence: Thomas Boland,
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Abstract
Coarctation of the aorta is an uncommon cause of treatment-resistant hypertension in adults. It is typically detected and treated in infancy or childhood with surgical or endovascular procedures. Most cases of recurrence of coarctation after repair occur in childhood or early adulthood; recurrence in older persons (>70 years) has rarely been reported. A 73-year-old woman was referred to us for the management of treatment-resistant hypertension accompanied by symptoms of claudication and headaches, which had resulted in multiple emergency room visits. Of note, 58 years earlier, a graft from the left subclavian artery had been used to bypass an aortic coarctation. During a hospitalization for severe hypertension accompanied by acute kidney injury and heart failure, diagnostic angiography revealed a complete thrombotic occlusion of the left subclavian-artery-to-descending-aorta bypass graft and a tight coarctation in the descending thoracic aorta. Balloon angioplasty and stenting across the coarctation was only transiently effective; subsequently, an ascending-to-descending graft was placed distal to the coarctation, and within a few days, the blood pressure levels and claudication improved markedly. This case demonstrates that hypertension specialists should suspect the possibility of recurrence of a coarctation in older patients who present with resistant hypertension and have a remote history of coarctation repair. Although such late recurrences are not common, as illustrated in our patient, surgical intervention may contribute to significant improvement in blood pressure control and prevent future complications.
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Soumer K, Derbel B, Benomrane S, Elleuch N, Kalfat T, Benmrad M, Ghedira F, Denguir R, Khayati A. [Middle aortic coarctation: a rare vascular disorder]. ACTA ACUST UNITED AC 2015; 40:42-8. [PMID: 25631642 DOI: 10.1016/j.jmv.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Coarctation of the descending thoracic aorta is uncommon, with controversial etiology. Usually, severe hypertension is the main symptom; lower extremity claudication is less often found. Surgical management remains the standard for long coarctation and provides good results. METHODS We report three cases of coarctation of the descending aorta operated at our department of cardiovascular surgery of Hospital La Rabta between January 2012 and December 2013. RESULTS The median age was 19 years and the median follow-up was 16 months. Hypertension was the most common clinical manifestation. The diagnosis was made by computed tomography angiography. Two cases were treated by an aorto-aortic bypass and one by subclavian-descending aorta bypass. Recovery was excellent, with a decrease in antihypertensive medications (four to two) and restoration of all distal pulses. CONCLUSIONS Middle aortic coarctation is a rare entity. Etiologies include congenital, acquired, inflammatory and infectious causes. The condition is considered a life-threatening emergency as a result of the complications associated with severe hypertension. Depending on technical considerations, open surgical bypass remains the standard repair for mid-aortic syndrome.
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Affiliation(s)
- K Soumer
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie.
| | - B Derbel
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - S Benomrane
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - N Elleuch
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - T Kalfat
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - M Benmrad
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - F Ghedira
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
| | - A Khayati
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, université de Tunis El Manar, hôpital La Rabta, 8, rue Ahmed El Mahdaoui, Borj Louzir, Ariana, Tunis 2073, Tunisie
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Ringel RE, Vincent J, Jenkins KJ, Gauvreau K, Moses H, Lofgren K, Usmani K. Acute outcome of stent therapy for coarctation of the aorta: Results of the coarctation of the aorta stent trial. Catheter Cardiovasc Interv 2013; 82:503-10. [DOI: 10.1002/ccd.24949] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/01/2013] [Accepted: 04/07/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Richard E. Ringel
- Division of Pediatric Cardiology; Department of Pediatrics; Johns Hopkins University School of Medicine; Baltimore; MD
| | - Julie Vincent
- Division of Pediatric Cardiology; Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian; New York; New York
| | - Kathy J. Jenkins
- Department of Cardiology; Boston Children's Hospital; Boston; MA
| | | | - Heidi Moses
- Department of Cardiology; Boston Children's Hospital; Boston; MA
| | - Kimberly Lofgren
- Department of Cardiology; Boston Children's Hospital; Boston; MA
| | - Kudret Usmani
- Department of Cardiology; Boston Children's Hospital; Boston; MA
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Ringel RE, Gauvreau K, Moses H, Jenkins KJ. Coarctation of the Aorta Stent Trial (COAST): study design and rationale. Am Heart J 2012; 164:7-13. [PMID: 22795276 DOI: 10.1016/j.ahj.2012.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/22/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Coarctation of the aorta (CoA) accounts for 4% to 5% of congenital cardiac abnormalities. Stent therapy has become an accepted alternative to surgery for older children and adults, although there are no balloon-expandable stents approved by the Food and Drug Administration for use in the aorta. The Cheatham-Platinum (CP) stent was designed for CoA therapy and is widely used outside the United States. We have designed the first prospective trial of stent therapy for CoA to serve as the pivotal trial for Food and Drug Administration approval of the CP stent. METHODS The COAST study is a prospective, multicenter, single-arm clinical study. The population includes patients with native or recurrent CoA. Four primary outcome variables were defined. For each variable, the stent will be compared to performance guidelines derived from surgical experience. The first efficacy outcome is reduction in arm-leg systolic blood pressure gradient, and the second is reduction in hospital length of stay. Safety outcomes include the following: the occurrence of any serious or somewhat serious adverse event attributed to the stent or implantation procedure and the occurrence of postprocedure paradoxical hypertension. A total of 105 patients treated with the CP stent will be enrolled. DISCUSSION To ascertain the effectiveness and safety of an interventional device, randomized controlled trials have been offered as the criterion standard. However, these trials are not well suited to study rare conditions such as CoA, especially once the therapy in question has received acceptance within the medical community. New clinical trial and statistical approaches are needed to evaluate such therapies. The COAST study is an example of this kind of innovative trial design.
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Hemels MEW, Hoendermis ES, van Melle JP, Pieper PG. Therapy refractory hypertension in adults: aortic coarctation has to be ruled out. Neth Heart J 2011; 19:107-111. [PMID: 21475399 PMCID: PMC3047687 DOI: 10.1007/s12471-011-0074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In patients with unexplained hypertension, especially in combination with a cardiac murmur, the presence of an aortic coarctation should always be ruled out given the high morbidity and mortality. However, particularly patients with an isolated coarctation often remain asymptomatic for years and the defect may be unnoticed even until the fifth or sixth decade of life. In the present article, we describe two patients with late detected coarctation to illustrate the clinical consequences, diagnostic clues for earlier detection and current therapeutic options to achieve optimal treatment. The key sign of an aortic coarctation, a difference in arterial blood pressure measured between the upper and lower extremities, should always be examined, followed by echocardiography. We conclude that even in case of a late detected severe coarctation, surgical or percutaneous repair has proven to be feasible and substantially effective, improving quality of life and lowering the risk of further hypertension-associated problems.
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Affiliation(s)
- M. E. W. Hemels
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - E. S. Hoendermis
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - J. P. van Melle
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - P. G. Pieper
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
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Charokopos N, Artemiou P, Antonitsis P, Rouska E, Stinios I. Repair of aortic coarctation in an adult by direct aortoplasty. Asian Cardiovasc Thorac Ann 2009; 17:516-8. [PMID: 19917797 DOI: 10.1177/0218492309348632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Various techniques have been proposed for surgical correction of aortic coarctation in adults. We describe direct aortoplasty repair in a 28-year-old woman with native coarctation. Four-year follow-up with magnetic resonance angiography confirmed a good result. This is a safe and effective technique that provides enlargement of the aortic lumen by avoiding extensive anastomotic suture lines or interposition of prosthetic graft material.
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Affiliation(s)
- Nicholas Charokopos
- First Department of Thoracic and Cardiovascular Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Walhout R, Suttorp M, Mackaij G, Ernst J, Plokker H. Long-term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue? Catheter Cardiovasc Interv 2009; 73:549-56. [DOI: 10.1002/ccd.21842] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tabbutt S, Nicolson SC, Dominguez TE, Wells W, Backer CL, Tweddell JS, Bokesch P, Schreiner M. Perioperative course in 118 infants and children undergoing coarctation repair via a thoracotomy: a prospective, multicenter experience. J Thorac Cardiovasc Surg 2008; 136:1229-36. [PMID: 19026808 DOI: 10.1016/j.jtcvs.2008.06.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 05/07/2008] [Accepted: 06/15/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The hospital course for pediatric coarctation repair has not been described. We had 4 aims: (1) to determine the influence of age, anatomy, and type of repair on aortic crossclamp time, (2) to determine the impact of age or aortic crossclamp time on postoperative morbidity, (3) to describe current antihypertensive strategies, and (4) to describe antihypertensive medications at hospital discharge. METHODS Data were obtained from a prospective randomized multicenter esmolol safety and efficacy trial. The study included patients who were scheduled for a coarctation repair receiving esmolol as their first-line antihypertensive medication in the operating room (n = 118; weight > or = 2.5 kg and age < 6 years). RESULTS (1) Patient age and type of coarctation did not affect the aortic crossclamp time. (2) Younger age, but not aortic crossclamp time, was associated with a significantly longer time to extubation and longer hospital length of stay. (3) A combination of esmolol and sodium nitroprusside (Nipride, Roche, Basel, Switzerland) provided excellent early blood pressure control. (4) At discharge, 64% of patients were receiving antihypertensive medications. Older patients were more likely to be discharged with antihypertensive medication (91% of patients aged 2-6 years, P < .0002). CONCLUSION The study describes a multi-institutional approach to the repair of isolated coarctation in infants and children. Patients repaired by end-to-end anastomosis had shorter aortic crossclamp time, younger patients had longer hospital length of stay, a majority of patients had sodium nitroprusside (Nipride) added to esmolol for early blood pressure control, and older patients were more likely to be discharged with antihypertensive medication.
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Affiliation(s)
- Sarah Tabbutt
- Cardiac Intensive Care Unit, The Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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Long-term prognosis of congenital heart defects: a systematic review. Int J Cardiol 2008; 131:25-32. [PMID: 18687485 DOI: 10.1016/j.ijcard.2008.06.023] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 05/12/2008] [Accepted: 06/06/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the large and expanding population of adults with congenital heart disease, little is known about their long-term outcome. By means of a systematic literature search, we aimed to assess the quantity and quality of data on long-term survival and morbidity in adults with common congenital heart defects. METHODS All literature on MEDLINE from January 1980 to January 2007 was searched, using a broad range of keywords for atrial septal defect, ventricular septal defect, pulmonary stenosis, tetralogy of Fallot, aortic coarctation, and transposition of the great arteries. After study selection using pre-specified criteria and quality assessment, data were extracted and weighed according to number of patients. Pooled estimates were obtained. RESULTS We identified 322 articles. Selection yielded 35 articles comprising 7894 patients. Data on survival were mainly available up until 40 years of age. In this young population, survival varied from 87.4% in aortic coarctation to 99.6% in atrial septal defect. Data on morbidity were sparse. Based on these data, morbidity was substantial. CONCLUSIONS Until the age of 40 years, survival is decreased in patients with congenital heart defects, albeit most pronounced among patients with complex heart defects. Moreover, morbidity is considerable in all defects. Sufficient data on long-term survival and morbidity beyond the age of 40 years are lacking, yet crucial for optimal clinical care.
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Rodés-Cabau J, Miró J, Dancea A, Ibrahim R, Piette E, Lapierre C, Jutras L, Perron J, Tchervenkow CI, Poirier N, Dahdah NS, Houde C. Comparison of surgical and transcatheter treatment for native coarctation of the aorta in patients > or = 1 year old. The Quebec Native Coarctation of the Aorta study. Am Heart J 2007; 154:186-92. [PMID: 17584575 DOI: 10.1016/j.ahj.2007.03.046] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Accepted: 03/28/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND The objectives of this study were to compare, in the current era, the immediate results, complications, and midterm outcomes obtained by surgical repair versus transcatheter treatment of coarctation of the aorta (CoA). METHODS The study was of retrospective nature and included 80 consecutive patients > or = 1 year old (mean age 12 +/- 10 years) treated for an isolated CoA in 4 university centers in Quebec between 1998 and 2004. Fifty patients underwent aortic angioplasty, with stent implantation in 19, and 30 had surgical repair. Immediate results, procedural complications, clinical events, and the incidence of aortic aneurysm at follow-up were compared between groups. RESULTS There were no differences between the 2 groups in clinical baseline characteristics. Percentage reduction in peak systolic pressure gradient across the coarctation was similar between the 2 groups (angioplasty 72% +/- 23% vs surgery 75% +/- 18%, P = .55). Procedure-related complications occurred more frequently after surgical repair compared with angioplasty (50% vs 18%, P = .005), and median hospitalization time was longer in the surgical than in the angioplasty group (7 vs 1 day, P < .001). At 38 +/- 21 months' follow-up, no patient in the surgical group and 16 patients in the angioplasty group had at least 1 aortic reintervention (0% vs 32%, P < .0001). The presence of an aortic aneurysm was diagnosed more frequently in the angioplasty group compared with the surgical group (24% vs 0%, P = .01). CONCLUSION Aortic angioplasty provided comparable immediate hemodynamic results to surgery, with reduced morbidity and hospitalization length for the treatment of CoA in patients > or = 1 year old. However, angioplasty was associated with a higher rate of reintervention and aneurysm formation at a mean follow-up of 3 years.
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Carr JA. The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol 2006; 47:1101-7. [PMID: 16545637 DOI: 10.1016/j.jacc.2005.10.063] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 10/02/2005] [Accepted: 10/12/2005] [Indexed: 02/07/2023]
Abstract
A review was performed to compare the results of endovascular therapy (stenting and angioplasty) with surgical techniques to repair adult aortic coarctation. The immediate improvement in hypertension and the morbidity were similar across all groups. Surgical therapy was associated with a very low risk of restenosis and recurrence, whereas endovascular therapy had a much higher incidence of restenosis and the need for repeat interventions. The long-term outcome of endovascular approaches will need to be assessed in the future.
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Affiliation(s)
- John Alfred Carr
- Department of Cardiovascular and Thoracic Surgery, University of Chicago, Chicago, Illinois 60637, USA.
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