Balloon Angioplasty of Recurrent Coarctation: 12-Year Review

Objectives. This study was undertaken to investigate the long-term outcome of balloon angioplasty for recurrent coarctation of the aort in large series of patients. Background. Balloon angioplasty has become the standard treatment for residual or recurrent aortic coarctation. Despite the widespread use of this treatment modality, there are few dat outlining the long-term outcome of large patient cohort. Methods. Clinical, echocardiographic, hemodynamic and angiographic dat on 90 consecutive patients who underwent balloon angioplasty between January 1984 and January 1996 were reviewed. Results. Mean systolic pressure gradients were reduced from 31 ± 21 to 8 ± 9 mm Hg after dilation (p = 0.0001). The mean diameter of the stenotic site, measured in the frontal and lateral views, increased by 38% and 35%, respectively (p = 0.001). Neurologic events occurred in two patients, with one death. An aortic tear occurred in one patient, requiring surgical intervention. Optimal results were defined as postprocedure gradient <20 mm Hg and were obtained acutely in 88% of patients. At long-term follow-up (12 years), 53 (72%) of 74 patients with an early optimal result remained free from reintervention. Transverse arch hypoplasia, defined as an arch dimension <2 SD below the mean for age, was the primary predictor of the need for reintervention. Conclusions. Although the majority of patients undergoing percutaneous balloon angioplasty for recoarctation of the aort will achieve long-term benefit, the need for further surgical intervention in those with transverse arch hypoplasi remains high.