Interventional Balloon Dilation/Stenting Is as Effective as Surgery in Improving Biventricular Performance in Neonates with Isolated Coarctation of the Aorta

Background: We investigated the clinical course and change in biventricular performance of neonates with isolated CoA, who underwent catheter intervention or surgical CoA repair in order to study whether initial balloon dilation/stent placement in newborns with isolated CoA is as effective as surgery in improving biventricular function.

Method: Retrospective cohort study of 26 consecutive neonates with isolated CoA, who underwent transcatheter intervention (balloon angioplasty/stent; n = 10) or surgical CoA repair (n = 16) at Hannover Medical School (2012–2021). We quantified biventricular function by advanced echocardiography, including strain analysis, at baseline and at hospital discharge.

Results: Cardiogenic shock at hospital admission was more frequent in the interventional versus the surgical cohort (50 vs. 25% of neonates). Echocardiographic isthmus diameter increased by 0.9 to 1.1 mm with therapy in both cohorts. Despite more severe systolic LV dysfunction in interventional patient, pretherapy (LVEF < 50% in 90% vs. 38% in surgical patients), all 26 patients fully recovered their biventricular function prior to hospital discharge. 2D speckle tracking analysis showed normalization of longitudinal, radial and circumferential LV strain as well as longitudinal RV free wall strain. At baseline, it was the longitudinal strain that was most notably reduced (LV: −12.3 vs. −16.3%; RV: −13.8 vs. −16.1% in the interventional and surgical patients, respectively). Improvements in diastolic strain variables indicate recovery of LV diastolic function prehospital discharge in both cohorts.

Conclusion: Percutaneous transcatheter intervention (balloon angioplasty ± coronary stent) is a feasible alternative to surgery for initial treatment of isolated neonatal CoA, and particularly suitable as rescue therapy for neonates with critical CoA who present with decompensated left heart failure.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023