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Balloon angioplasty is preferred to surgery for aortic coarctation

Published online by Cambridge University Press:  21 January 2008

Derek Wong ,
Lee N. Benson ,
Glen S. Van Arsdell ,
Tara Karamlou  and
Brian W. McCrindle
Derek Wong
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Lee N. Benson
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Glen S. Van Arsdell
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Tara Karamlou
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Brian W. McCrindle*
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
*
The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, CanadaM5G 1X8. Tel: +416 813 7610; Fax: +416 813 7547; E-mail: [email protected]
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Abstract

Objective

We sought to use techniques of decision analysis to compare values or preferences for balloon angioplasty versus surgery for treatment of aortic coarctation in children.

Background

Balloon angioplasty and surgery for aortic coarctation have a differing spectrum and prevalence of outcomes and complications, making direct comparison difficult.

Methods

From articles reporting treatment outcomes of native aortic coarctation from 1984 through 2005, we determined the baseline probabilities of successful treatment, complications, recoarctation and aneurysmal formation. Decision trees with baseline probabilities of these outcomes were formulated. Standard gamble interviews of medical professionals determined the preferences for the various outcomes. Final cumulative preference scores were further adjusted for both perceived mortality and procedural disutility. Sensitivity analyses determined threshold probabilities at which the score advantage changed.

Results

Final preference scores for balloon angioplasty, with a mean of 0.8999, and standard deviation of 0.0236, were significantly higher than for surgery, at a mean of 0.8873, and standard deviation of 0.0246. The score advantage for balloon angioplasty did not change when adjusted for disutility, or mortality. Sensitivity analysis showed that even if the probability of periprocedural death or major complications for surgery was reduced to none, balloon angioplasty would still be preferred, expect for neonates, where if surgical mortality were reduced below 4%, then surgery would be preferred. Probabilities for periprocedural death or major complications associated with balloon angioplasty would have to exceed plausible thresholds before surgery would be preferred.

Conclusions

After accounting for preference-weighted probabilities of outcomes, balloon angioplasty is preferred over surgery for all plausible situations as the initial treatment for native aortic coarctation in children.

Keywords

Congenital cardiac surgeryinterventional catheterizationdecision analysis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 1 , February 2008 , pp. 79 - 88
Copyright
Copyright © Cambridge University Press 2008

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References

1. Reynolds, JL. Coarctation of the aorta treated by transvascular balloon angioplasty. J La State Med Soc 1984; 136: 47–49.Google ScholarPubMed
2. Finley, JP, Beaulieu, RG, Nanton, MA, Roy, DL. Balloon catheter dilatation of coarctation of the aorta in young infants. Br Heart J 1983; 50: 411–415.CrossRefGoogle ScholarPubMed
3. Sperling, DR, Dorsey, TJ, Rowen, M, Gazzaniga, AB. Percutaneous transluminal angioplasty of congenital coarctation of the aorta. Am J Cardiol 1983; 51: 562–564.CrossRefGoogle ScholarPubMed
4. Singer, MI, Rowen, M, Dorsey, TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J 1982; 103 (1): 131–132.CrossRefGoogle ScholarPubMed
5. Shaddy, RE, Boucek, MM, Sturtevant, JE, et al. . Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation 1993; 87: 793–799.CrossRefGoogle ScholarPubMed
6. Hernandez-Gonzalez, M, Solorio, S, Conde-Carmona, I, et al. . Intraluminal aortoplasty vs. surgical aortic resection in congenital aortic coarctation. A clinical random study in pediatric patients. Arch Med Res 2003; 34: 305–310.CrossRefGoogle ScholarPubMed
7. Shim, D, Lloyd, TR, Moorehead, CP, Bove, EL, Mosca, RS, Beekman, RH III. Comparison of hospital charges for balloon angioplasty and surgical repair in children with native coarctation of the aorta. Am J Cardiol 1997; 79: 1143–1146.CrossRefGoogle ScholarPubMed
8. George, JC, Shim, D, Bucuvalas, JC, et al. . Cost-Effectiveness of coarctation repair strategies: endovascular stenting versus surgery. Pediatr Cardiol 2003; 24: 544–547.CrossRefGoogle ScholarPubMed
9. Cowley, CG, Orsmond, GS, Feola, P, McQuillan, L, Shaddy, RE. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation 2005; 111: 3453–3456.CrossRefGoogle ScholarPubMed
10. Detsky, AS, Naglie, G, Krahn, MD, Naimark, D, Redelmeier, DA. Primer on medical decision analysis: Part 1- Getting started. Med Decis Making 1997; 17: 123–125.CrossRefGoogle ScholarPubMed
11. Detsky, AS, Naglie, G, Krahn, MD, Redelmeier, DA, Naimark, D. Primer on medical decision analysis: Part 2- Building a tree. Med Decis Making 1997; 17: 126–135.CrossRefGoogle ScholarPubMed
12. Krahn, MD, Naglie, G, Naimark, D, Redelmeier, DA, Detsky, AS. Primer on medical decision analysis: Part 4- Analyzing the model and interpreting the results. Med Decis Making 1997; 17: 142–151.CrossRefGoogle ScholarPubMed
13. Naglie, G, Krahn, MD, Naimark, D, Redelmeier, DA, Detsky, AS. Primer on medical decision analysis: Part 3- Estimating probabilities and utilities. Med Decis Making 1997; 17: 136–141.CrossRefGoogle ScholarPubMed
14. Naimark, D, Krahn, MD, Naglie, G, Redelmeier, DA, Detsky, AS. Primer on medical decision analysis: Part 5 Working with Markov processes. Med Decis Making 1997; 17: 152–159.CrossRefGoogle ScholarPubMed
15. de Giovanni, JV. Covered stents in the treatment of aortic coarctation. J Interv Cardiol 2001; 14: 187–190.CrossRefGoogle ScholarPubMed
16. Hamdan, MA, Maheshwari, S, Fahey, JT, Hellenbrand, WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 2001; 38: 1518–1523.CrossRefGoogle ScholarPubMed
17. Piechaud, JF. Stent implantation for coarctation in adults. J Interv Cardiol 2003; 16: 413–418.CrossRefGoogle ScholarPubMed
18. Santoro, G, Carminati, M, Bigazzi, MC, et al. . Primary stenting of native aortic coarctation. Tex Heart Inst J 2001; 28: 226–227.Google ScholarPubMed