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Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood

Früh, Seraina ; Knirsch, Walter ; Dodge-Khatami, Ali ; Dave, Hitendu ; Prêtre, René ; Kretschmar, Oliver

In: European Journal of Cardio-Thoracic Surgery, 2011, vol. 39, no. 6, p. 898-904

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    Titel
    • Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood
    Autor
    • Früh, Seraina. Division of Pediatric and Congenital Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Knirsch, Walter. Division of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
    • Dodge-Khatami, Ali. Division of Pediatric and Congenital Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Dave, Hitendu. Division of Pediatric and Congenital Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Prêtre, René. Division of Pediatric and Congenital Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Kretschmar, Oliver. Division of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • European Journal of Cardio-Thoracic Surgery, 2011, vol. 39, no. 6, p. 898-904. Elsevier Science B.V.
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:300379
    Summary
    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) were both comparable between the three age groups (complications: group A 8.3%, group B 6.3%, and group C 3.7%; re-interventions: group A 16.6%, group B 18.8%, and group C 18.5%). 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