Acute Results of Balloon Angioplasty of Native Coarctation Versus Recurrent Aortic Obstruction Are Equivalent

Objectives. This study sought to compare the immediate results and risk factors for suboptimal outcomes of percutaneous balloon angioplasty for native versus recurrent aortic obstruction. Background. Some cardiology centers have been reluctant to adopt balloon angioplasty for treatment of native aortic coarctation, while advocating balloon angioplasty over an operation for treatment of postsurgical or recurrent aortic obstruction. Methods. Acute results were analyzed from 970 procedures (422 native and 548 recurrent lesions) performed between 1982 and 1995 in 907 patients from 25 centers. An acute suboptimal outcome was defined as one or more of the following: residual systolic pressure gradient ≥20 mm Hg, residual proximal to distal systolic pressure ratio ≥1.33 or major complication (death, aortic transmural tear, stroke). Results. Balloon angioplasty significantly (p = 0.0001) increased lesion diameter for both native (mean [±SD] 128 ± 94%) and recurrent aortic obstruction (97 ± 87%), with significantly greater increase in the native group (p = 0.0001). reduction in systolic pressure gradients was significant in both groups (p = 0.0001), but slightly higher (p = 0.01) for native (−74 ± 24%) versus recurrent obstruction (−70 ± 31%). Death associated with angioplasty was reported in 0.7% of patients with native and in 0.7% of patients with recurrent lesions (p = 1.00). An acute suboptimal outcome was noted with angioplasty in 19% of native and in 25% of recurrent lesions (p = 0.04). Significant independent risk factors included higher preangioplasty systolic gradient (odds ratio [OR] 1.39/10-mm Hg increment; 95% confidence interval [CI] 1.28 to 1.50, p = 0.0001), earlier study date (OR 0.92/1-year increment, 95% CI 0.87 to 0.96, p = 0.0006), older age (OR 1.13/5-year increment, 95% CI 1.02 to 1.26, p = 0.02) and recurrent obstruction (OR 1.39 vs. native lesions, 95% CI 1.00 to 1.94, p = 0.05). Conclusions. Acute results and complications of balloon angioplasty of native coarctation appear to be equivalent or slightly superior to those of recurrent aortic obstructions.