Balloon angioplasty versus surgery in the treatment of pediatric native coarctation of the aorta: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yuhao ^1,4,5,6 , XIN Liangjing ² , ZHOU Yuehang ^1,4,5,6 , JIN Xin ^1,4,5,6 , LI Yonggang ^1,4,5,6 , KUANG Hongyu ^3,4,5,6 ,  WU Chun ^1,4,5,6

1. Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, P.R.China;
2. Department of Orthodontics, Stomatological hospital of Chongqing Medical University, Chongqing, 400014, P.R.China;
3. Department of Cardiology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, P.R.China;
4. Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, P.R.China;
5. China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, P.R.China;
6. Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P.R.China;

Corresponding author：

WU Chun, Email: wuchun007@sina.com

Keywords：

Coarctation of the aorta; balloon angioplasty; surgery; treatment outcome

DOI：

10.7507/1007-4848.201802021

Video：

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Objective A meta-analysis was performed for a comparison of outcomes between surgery and balloon angioplasty (BA) for native coarctation of the aorta (NCA) in pediatric patients. Methods Electronic databases, including PubMed, EMbase, Medline, Cochrane Library, Weipu Data, Wanfang Data and CNKI were searched systematically for the literature aimed mainly at comparing the therapeutic effects for NCA administrated by surgery and BA. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Ten studies meeting the inclusion criteria were included, involving a total of 723 subjects. It was observed that compared with BA, surgery was significantly associated with a lower incidence of recoarctation (OR, 0.43; 95%CI, 0.30–0.63; P<0.001), repeat intervention due to recoarctation (OR, 0.40; 95%CI, 0.27–0.61;P<0.001) and lower residual transcoarctation gradient in mid to long term follow up (WMD –0.85; 95%CI, –12.34 to –3.76;P<0.001). Compared with BA, surgery was significantly associated with a longer hospitalization time (WMD, 19.40; 95%CI, 15.82–22.99;P<0.001). Incidence of aneurysm formation (OR, 0.64; 95%CI, 0.26–1.57;P=0.33), complications(OR, 1.77; 95%CI, 0.95–3.28; P=0.07), perioperative mortality (OR, 2.57; 95%CI, 0.87–7.61, P=0.09) and immediate transcoarctation residual gradient (WMD –1.66; 95%CI, –4.23–0.90; P=0.2) were not statistically different between surgery and BA. Conclusions Compared with BA, surgery was significantly associated with a lower incidence of recoarctation, repeat intervention due to re-CoA and residual transcoarctation gradient in mid to long term follow up. On the contrary, BA was significantly associated with a shorter hospitalization time. Incidence of aneurysm formation, perioperative mortality, complications and immediate transcoarctation residual gradient were similar between surgery and BA.

1.	Baykan A, Narin N, Ozyurt A, et al. Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey. Cardiol Young, 2014, 24(4): 675-684.
2.	Crafoord C, Nylin G et al. Congenital coarctation of the aorta and its surgical treatment. J Thoracic Surg, 1945, 14: 347-361.
3.	Singer M I, Rowen M, Dorsey T J. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J, 1982, 103(1): 131-132.
4.	Wells G A, Shea B J, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. Appl Eng Agric, 2014, 18(6): 727-734.
5.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.
6.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Naunyn Schmiedebergs Arch Pharmacol 5(2): S38.
7.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.
8.	Fariba A, Arabi M M Y, Hojat M, et al. Balloon Angioplasty versus Surgical Repair of Coarctation of Aorta in Infants. J Tehran Heart Cent, 2011, 6(3): 134-137.
9.	Chiu H H, Chiu S N, Hu F C, et al. Late Cardiovascular Complications After Surgical or Balloon Angioplasty of Coarctation of Aorta in an Asian Cohort. Am J Cardiol, 2009, 104(8): 1139.
10.	Zhang H, Ye M, Chen G, et al. A comparison of balloon angioplasty of native coarctation versus surgical repair for short segment coarctation associated with ventricular septal defect—a single-center retrospective review of 92 cases. J Thorac Dis, 2016, 8(8): 2046-2052.
11.	Lin S M, Hwang H K, Wu S J, et al. Comparison Between Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Neonates and Young Infants. Acta Cardiol Sin, 2008, 24(4): 204-208.
12.	Dijkema E J, Sieswerda G T, Takken T, et al. Long-term results of balloon angioplasty for native coarctation of the aorta in childhood in comparison with surgery. Eur J Cardiothorac Surg, 2017.
13.	Walhout R J, Lekkerkerker J C, Oron G H, et al. Comparison of surgical repair with balloon angioplasty for native coarctation in patients from 3 months to 16 years of age. Eur J Cardiothorac Surg, 2004, 25(5): 722-727.
14.	Fiore A C, Fischer L K, Schwartz T, et al. Comparison of angioplasty and surgery for neonatal aortic coarctation. Ann Thorac Surg, 2005, 80(5): 1664-1665.
15.	Hernández-González M, Solorio M, Conde-Carmona I, et al. Intraluminal aortoplasty vs. surgical aortic resection in congenitalaortic coarctation: A clinical random study in pediatric patients. Arch Med Res, 2003, 34(4): 305-310.
16.	Rao P S, Chopra P S, Koscik R, et al. Surgical versus balloon therapy for aortic coarctation in infants ≤ 3 months old. J Am Coll Cardiol, 1994, 23(6): 1479-1483.
17.	Cowley C G, Orsmond G S, Feola P, et al. Long-Term, Randomized Comparison of Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Childhood. Circulation, 2005, 111(25): 3453-3456.
18.	Suárez d L J, Pan M, Romero M, et al. Percutaneous interventions on severe coarctation of the aorta: a 21-year experience. Pediatr Cardiol, 2005, 26(2): 176-189.
19.	Lee C L, Lin J F, Hsieh K S, et al. Balloon angioplasty of native coarctation and comparison of patients younger and older than 3 months. Circ J, 2007, 71(11): 1781.
20.	Wong D, Benson L A G, Karamlou T, et al. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young, 2008, 18(1): 79.
21.	Patel H T, Madani A, Paris Y M, et al. Balloon Angioplasty of Native Coarctation of the Aorta in Infants and Neonates: Is It Worth the Hassle? . Pediatr Cardiol, 2001, 22(1): 53-57.
22.	Feltes TF, Bacha E, Beekman RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011; 123: 2607-2652.
23.	Karl T R. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med, 2007, 8(8): 50-56.
24.	Torok R D, Campbell M J, Fleming G A, et al. Coarctation of the aorta:Management from infancy to adulthood. World J Cardiol, 2015, 7(11): 765-775.
25.	Jaureguizar E, Vazquez J, Murcia J, et al. Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fstula. J Pediatr Surg 20(5): 511-514.
26.	Hu Z P, Wang Z W, Dai X F, et al. Outcomes of Surgical versus Balloon Angioplasty Treatment for Native Coarctation of the Aorta: A Meta-Analysis. Ann Vasc Surg, 2014, 28(2): 394.
27.	Shaddy R E, Boucek M M, Sturtevant J E, et al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation, 1993, 87(3): 793-799.
28.	George J C, Shim D, Bucuvalas J C, et al. Cost effectiveness of coarctation strategies: endovascular stent versus surgery. J Am Coll Cardiol, 2002, 39(02): 410-410.
29.	Baykan A, Narin N, Ozyurt A, et al. Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey. Cardiol Young, 2014, 24(4): 675-84.
30.	Ang H L, Lim C W, Hia C, et al. Coarctation of the aorta: nonsurgical treatment using stent implantation. Singapore Med J, 2014, 55(6): 302-304.

1. Baykan A, Narin N, Ozyurt A, et al. Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey. Cardiol Young, 2014, 24(4): 675-684.
2. Crafoord C, Nylin G et al. Congenital coarctation of the aorta and its surgical treatment. J Thoracic Surg, 1945, 14: 347-361.
3. Singer M I, Rowen M, Dorsey T J. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J, 1982, 103(1): 131-132.
4. Wells G A, Shea B J, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. Appl Eng Agric, 2014, 18(6): 727-734.
5. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.
6. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Naunyn Schmiedebergs Arch Pharmacol 5(2): S38.
7. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.
8. Fariba A, Arabi M M Y, Hojat M, et al. Balloon Angioplasty versus Surgical Repair of Coarctation of Aorta in Infants. J Tehran Heart Cent, 2011, 6(3): 134-137.
9. Chiu H H, Chiu S N, Hu F C, et al. Late Cardiovascular Complications After Surgical or Balloon Angioplasty of Coarctation of Aorta in an Asian Cohort. Am J Cardiol, 2009, 104(8): 1139.
10. Zhang H, Ye M, Chen G, et al. A comparison of balloon angioplasty of native coarctation versus surgical repair for short segment coarctation associated with ventricular septal defect—a single-center retrospective review of 92 cases. J Thorac Dis, 2016, 8(8): 2046-2052.
11. Lin S M, Hwang H K, Wu S J, et al. Comparison Between Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Neonates and Young Infants. Acta Cardiol Sin, 2008, 24(4): 204-208.
12. Dijkema E J, Sieswerda G T, Takken T, et al. Long-term results of balloon angioplasty for native coarctation of the aorta in childhood in comparison with surgery. Eur J Cardiothorac Surg, 2017.
13. Walhout R J, Lekkerkerker J C, Oron G H, et al. Comparison of surgical repair with balloon angioplasty for native coarctation in patients from 3 months to 16 years of age. Eur J Cardiothorac Surg, 2004, 25(5): 722-727.
14. Fiore A C, Fischer L K, Schwartz T, et al. Comparison of angioplasty and surgery for neonatal aortic coarctation. Ann Thorac Surg, 2005, 80(5): 1664-1665.
15. Hernández-González M, Solorio M, Conde-Carmona I, et al. Intraluminal aortoplasty vs. surgical aortic resection in congenitalaortic coarctation: A clinical random study in pediatric patients. Arch Med Res, 2003, 34(4): 305-310.
16. Rao P S, Chopra P S, Koscik R, et al. Surgical versus balloon therapy for aortic coarctation in infants ≤ 3 months old. J Am Coll Cardiol, 1994, 23(6): 1479-1483.
17. Cowley C G, Orsmond G S, Feola P, et al. Long-Term, Randomized Comparison of Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Childhood. Circulation, 2005, 111(25): 3453-3456.
18. Suárez d L J, Pan M, Romero M, et al. Percutaneous interventions on severe coarctation of the aorta: a 21-year experience. Pediatr Cardiol, 2005, 26(2): 176-189.
19. Lee C L, Lin J F, Hsieh K S, et al. Balloon angioplasty of native coarctation and comparison of patients younger and older than 3 months. Circ J, 2007, 71(11): 1781.
20. Wong D, Benson L A G, Karamlou T, et al. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young, 2008, 18(1): 79.
21. Patel H T, Madani A, Paris Y M, et al. Balloon Angioplasty of Native Coarctation of the Aorta in Infants and Neonates: Is It Worth the Hassle? . Pediatr Cardiol, 2001, 22(1): 53-57.
22. Feltes TF, Bacha E, Beekman RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011; 123: 2607-2652.
23. Karl T R. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med, 2007, 8(8): 50-56.
24. Torok R D, Campbell M J, Fleming G A, et al. Coarctation of the aorta:Management from infancy to adulthood. World J Cardiol, 2015, 7(11): 765-775.
25. Jaureguizar E, Vazquez J, Murcia J, et al. Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fstula. J Pediatr Surg 20(5): 511-514.
26. Hu Z P, Wang Z W, Dai X F, et al. Outcomes of Surgical versus Balloon Angioplasty Treatment for Native Coarctation of the Aorta: A Meta-Analysis. Ann Vasc Surg, 2014, 28(2): 394.
27. Shaddy R E, Boucek M M, Sturtevant J E, et al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation, 1993, 87(3): 793-799.
28. George J C, Shim D, Bucuvalas J C, et al. Cost effectiveness of coarctation strategies: endovascular stent versus surgery. J Am Coll Cardiol, 2002, 39(02): 410-410.
29. Baykan A, Narin N, Ozyurt A, et al. Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey. Cardiol Young, 2014, 24(4): 675-84.
30. Ang H L, Lim C W, Hia C, et al. Coarctation of the aorta: nonsurgical treatment using stent implantation. Singapore Med J, 2014, 55(6): 302-304.

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