On the role of balloon angioplasty in infantile and childhood coarctation of aorta

Balloon angioplasty (BA) for ‘native’ coarctation of the aorta (CoA) in infants and young children remains controversial. In this study, the aim is to evaluate the immediate and mid-term outcome of BA. Methods A prospective, interventional study conducted in a tertiary, high volume cardiac centre, over a 30-month period, ending May 2017. BA was preceded by preoperative clinical examination, and a detailed cardiac ultrasound and catheterization assessment. A statistical analysis was performed – including logistic regression and Kaplan–Meier tests. Results The study included 74 patients with a median age of 10 months (inter-quartile range – IQR, 5–61) BA was ‘successful’ in 66 (89%) cases, with a decrease in peak pressure gradient (PG) and an angiographic improvement of 59% (95% confidence interval – CI, 56–63; P < 0.001) and 85% (95% CI, 83–87; P < 0.0001), respectively. Recurrence was reported in 19 (26%) cases. Long-segment CoA was the best predictor of recurrence (adjusted OR, 72; 95% CI, 4–1295; P = 0.004). BA was most ‘durable’ in those older than 12 months – 88% of those older than 12 months had freedom from recurrence. The mean time-to-event was 25 months (95% CI, 22–28). Ileofemoral artery occlusion was the most common complication ( n = 5; 7%), followed by dissection ( n = 4; 5%). Conclusions BA is a feasible option to treat native CoA in infants and children, with good immediate and mid-term outcomes. This study contributes to the growing body of information, supporting the role and effectiveness of BA in this setting.