Long-Term Outcomes of Native Coarctation of the Aorta after Balloon Angioplasty or Surgical Aortoplasty in Newborns and Young Infants Less Than 3 Months of Age

Background: Balloon angioplasty of native coarctation of the aorta, though effective, is frequently associated with early restenosis, repeated interventions and aneurysm formation, especially in very young patients. However, available long-term data are limited. Methods: From Jan. 1986 to Dec. 2007, eighty-eight patients with simple aortic coarctation, isolated or associated with patent ductus arteriosus or ventricular septal defect, and survived angioplasty (n = 17) or surgery (n = 71) within 3 months of age in National Taiwan University Hospital were enrolled. Results: The average length of follow-up was 10.1 +/- 5.1 years. The long-term outcomes between these two groups were comparable in hypertension, left ventricular outflow tract obstruction, and aortic aneurysm. Patients in the angioplasty group had a greater likelihood of reintervention (64.7% vs. 42.3%, p = 0.096) and repeated reintervention (29.4% vs. 7.0%, p = 0.027) as compared with surgery group. The 10-year freedom from reintervention was 35.3% and 59.2% in the angioplasty and surgery group, respectively (p = 0.046); there were no deaths reported in that 10-year span. Patients with angioplasty and those with patent ductus arteriosus were more likely to require surgical aortoplasty at reintervention. Conclusions:The long-term outcomes of aortic coarctation in newborns and young infants after balloon angioplasty were effective and beneficial. However, those outcomes were accompanied by concomitant higher risks of reintervention and surgical reintervention, particularly in those with patent ductus arteriosus.