Stent, angioplasty or surgery for coarctation of aorta?

Forbes TJ and colleagues [Comparison of Surgical, Stent, and Balloon Angioplasty Treatment of Native Coarctation of the Aorta. An Observational Study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol, 2011; 58:2664-2674] conducted a non randomized observational study comparing stenting, balloon angioplasty and surgery for coarctation of aorta in children weighing more than ten kilograms. The study period was between 2002 and 2009, involving three hundred and fifty patients from thirty six institutions. They collected baseline, acute, short term (three to eighteen months) and intermediate follow up beyond eighteen months. Stents were implanted in two hundred and seventeen patients while sixty one had undergone just balloon angioplasty. There were seventy two patients who underwent surgical correction. Stent was superior to balloon angioplasty in coarctation of aorta in achieving a lower upper limb to lower limb gradient acutely. Surgery was superior to stent in coarctation of aorta in terms of the gradient at short term follow up. As expected, stent patients had shorter hospital stay than the surgical cases (2.4 versus 6.4 days; p < 0.001). They had also fewer complications than the balloon angioplasty and surgical patients (2.3%, 9.8%, and 8.1%; p < 0.001). Aortic wall injury was more likely in balloon angioplasty cases. Authors advised caution while interpreting the results of this report because of the non randomized nature of the study.

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