Outcomes of surgical versus balloon angioplasty treatment for native coarctation of the aorta: a meta-analysis.

ABSTRACT

BACKGROUND: Native coarctation of the aorta (COA) accounts for 5-7% of congenital heart disease. Open surgical treatment was the only choice until balloon angioplasty (BA) treatment was introduced as an alternative therapy for COA in the 1980s. BA treatment was thought to be a less invasive and potentially safer technique, and has been used on numerous patients. But as has been reported during the past 30 years, the risk of aneurysm formation and recoarctation existed in either of those 2 procedures. Unfortunately, follow-up for either type of treatment has been limited, making it difficult to draw any meaningful conclusions as to which treatment option is superior. Our objective was to compare results of 2 therapeutic modalities to treat native COA BA without stent implantation and surgery. METHODS: We performed a meta-analysis of controlled trials of surgical versus BA treatment for native COA. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and the Chinese Biomedical Database of clinical trials were searched using PubMed and OVID. Controlled trials in which patients with COA were assigned to surgical repair or BA treatment were included. For each outcome, we evaluated the quality of the evidence with reference to the Grading of Recommendations Assessments, Development, and Evaluation criteria. We used RevMan 5.1 software (The Nordic Cochrane Centre, Copenhagen, Denmark) to analyze the data. RESULTS: A literature search yielded 9 comparable studies, for a total of 623 patients, of whom 378 and 245 were assigned to surgery and BA. Meta-analysis of these studies showed no significant difference in postintervention gradient (inverse variance fixed mean difference 1.44 [95% CI -1.16 to 4.04]), midterm recoarctation (Mantel-Haenszel [M-H] random odds ratio [OR] 0.24 [95% CI 0.04-1.58]), and long-term recoarctation (M-H fixed OR 0.61 [95% CI 0.34-1.11]). BA reduces the risk of severe complications (M-H fixed OR 2.67 [95% CI 1.37-5.21]; P < 0.001) but increases the risk of short-term recoarctation (M-H fixed OR 0.25 [95% CI] 0.12-0.54]; P < 0.001) and aortic aneurysm formation (M-H fixed OR 0.12 [95% CI] 0.04-0.34]; P < 0.001). CONCLUSIONS: BA provides immediate results comparable to surgery and reduces invasion, but it does not provide better results compared with surgery when considering medium- and long-term complications and even increases the incidence of aneurysm formation.