Elsevier

Archives of Medical Research

Volume 34, Issue 4, July–August 2003, Pages 305-310
Archives of Medical Research

Original article
Intraluminal aortoplasty vs. surgical aortic resection in congenitalaortic coarctation: A clinical random study in pediatric patients

https://doi.org/10.1016/S0188-4409(03)00055-9Get rights and content

Abstract

Background. Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated.

Methods. A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05.

Results. There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant.

Conclusions. Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.

Introduction

Since 1944 and for the following 35 years, surgical resection was the sole modality used for aortic coarctation treatment. Intraluminal angioplasty has been an alternate form of aortic coarctation treatment practiced during the last 10 years. Currently, surgical correction is recommended in newborns with aortic coarctation or in patients with aortic coarctation associated with persistent ductus arteriosus 1., 2., 3., 4., 5., 6., 7., 8., 9.. Comparing diverse surgical techniques, long-term follow-up studies have shown that better results were obtained with coarctation resection and end-to-end anastomosis 10., 11., 12., 13., 14..

In the past, intraluminal balloon aortic angioplasty achieved great popularity. At present, there are numerous reports with regard to mean-term results of aortic angioplasty in aortic coarctation and re-coarctation frequency, complications, and mortality related to the procedure have been studied 15., 16., 17..

To our knowledge, there are few reports comparing surgery vs. angioplasty mid- to late and long-term results. Therefore, we designed a prospective study comparing results of aortic coarctation resection vs. aortic intraluminal balloon dilation.

Section snippets

Materials and methods

We studied male and female pediatric patients with congenital aortic coarctation, 1 to 16 years of age including patients with clinical diagnosis of aortic coarctation and trans-coarctation gradient ≥20 mmHg (determined by echocardiography or catheterization). Our investigation began in August 1997, and follow-up continued for 6 months to 1 year. The study was multicentric: patients were gathered from several childrens' hospitals affiliated with the National Health System of Mexico, including

Results

We studied 58 patients, 30 for group A and 28 for group B. No differences (p > 0.05) were found concerning patient gender, age, weight, height, or severity of aortic hypoplasia (Table 1). Echocardiographic trans-coarctation pressure gradient was 46.8±18.94 mmHg for group A prior to treatment and 13.13±10.13 mmHg after treatment (aortic angioplasty). Trans-coarctation pressure gradient was 51.96±13.89 mmHg prior to treatment and 11.28±9.25 mmHg after treatment for group B patients (surgery).

Discussion

Because of random assignment to treatment characteristics of our study, patients of both groups were eligible. This fact guaranteed good control of variables, avoiding uncontrolled modification in outcome.

Efficacy of surgical resection of aortic coarctation has been proven in pediatric patients. Many cohort studies over 35 years were performed to compare variant surgical techniques. These studies showed that aortic resection and end-to-end anastomosis had better results than other techniques 6.

Acknowledgements

This study was supported by TELMEX (Teléfonos de México), CONACYT (Consejo Nacional de Ciencia y Tecnologı́a), México, and IMSS (Instituto Mexicano del Seguro Social), México.

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