Open Access

ARTICLE

Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up

by Marie Laure Yammine^#,*, Camilla Calvieri^#, Marcello Chinali, Salvatore Giannico, Giulia Cafiero, Ugo Giordano

Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, Institute for Treatment and Research, Piazza S. Onofrio 4, Rome, 00165, Italy

* Corresponding Author: Marie Laure Yammine. Email:
# Both authors have equally contributed to this work

Congenital Heart Disease 2021, 16(5), 457-467. https://doi.org/10.32604/CHD.2021.015896

Received 22 January 2021; Accepted 04 March 2021; Issue published 03 June 2021

Abstract

Background: In recent decades, aortic stenting has become a promising alternative to surgery for both native aortic coarctation and re-stenosis in children and adults. However, comparative long-term outcomes have poorly been investigated. Methods: We included 212 patients with previous aortic repair (19 ± 8.7 years) divided into 3 groups: 139 with single-time surgical repair (CoA-S group); 18 with single-time percutaneous stenting (CoA-PS group); and 55 hybrid patients with multiple aortic procedures because of re-coarctation occurrence (CoA-H group). All patients underwent 24-hour ambulatory blood pressure monitoring and trans-thoracic echocardiography. Results: After a median follow-up of 17 years after aortic repair, antihypertensive therapy was recorded in a significantly higher proportion of patients (83%) in CoA-PS group compared to 65% and 46% of CoA-H and CoA-S groups, respectively (p = 0.002). Pulse pressure values were higher in CoA-PS patients compared to the others (p < 0.001). Echocardiogram showed significant residual aortic gradient in 50% of CoA-PS and 73% of CoA-H patients compared to 33% of CoA-S patients (p < 0.0001). Indeed, stenting was associated to higher incidence of re-coartaction (p < 0.0001). At multivariate regression Cox analysis adjusted for age at repair and need for antihypertensive therapy, percutaneous stenting was an independent predictor of echocardiographic evidence of re-coarctation (p ≤ 0.001). Conclusion: Aortic coarctation stenting was independently associated with re-coartaction occurrence during long-term follow up when compared to surgical procedures. Furthermore, patients with aortic stenting had lower blood pressure control at 24-hour ambulatory blood pressure monitoring and higher need for antihypertensive therapy.

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