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(Circulation. 2005;111:3347-3348.)
© 2005 American Heart Association, Inc.

Editorial

Leaving Neverland

A Randomized Trial for Coarctation Shows Pediatric Interventional Cardiology Is Growing Up

Audrey C. Marshall, MD; James E. Lock, MD

From the Department of Cardiology, Children’s Hospital, Boston, and the Department of Pediatrics, Harvard Medical School, Boston, Mass.

Correspondence to Audrey C. Marshall, MD, Department of Cardiology, Children’s Hospital, Boston, 300 Longwood Ave, Boston, MA 02115. E-mail Audrey.marshall@cardio.chboston.org

Key Words: Editorials • coarctation • aorta • pediatrics • angioplasty

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Coarctation of the aorta is commonly considered a relatively simple form of congenital heart disease. On the basis of early knowledge of the significant mortality associated with unrepaired coarctation, surgical therapy was first developed and performed in the mid-1940s.^1–3 In many ways, the seemingly simple problem of pediatric coarctation has lent itself to a myriad of treatment strategies, including transcatheter intervention. The community of pediatric cardiologists and cardiac surgeons, faced with these broad options, has failed to reach consensus about optimal management. Even 12 years after publishing the early results of a randomized trial comparing angioplasty with surgery in the treatment of children with coarctation, Cowley and colleagues continue to acknowledge the ongoing and active controversy surrounding the topic.^4,5

See p 3453

In this issue of Circulation, Cowley and colleagues present the long-term results of this trial, with a relatively small number of patients and incomplete follow-up. Using a composite outcome that comprises reinterventions and aneurysm formation, the authors draw the tentative conclusion that surgery may provide better long-term outcomes than does balloon angioplasty. This conclusion can be challenged on a number of fronts. For example, the need for 2 catheterizations may not necessarily be considered a poorer outcome than a single thoracotomy. Furthermore, as with all long-term outcomes in developing fields, the results reflect only those of older practices. Increased experience with angioplasty techniques and the use of aortic stents have likely altered both short- and long-term results of angioplasty for coarctation.⁶ Similarly, as the authors note, surgical . . . [Full Text of this Article]

Related Article:

Long-Term, Randomized Comparison of Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Childhood

Collin G. Cowley, Garth S. Orsmond, Peter Feola, Lon McQuillan, and Robert E. Shaddy
Circulation 2005 111: 3453-3456. [Abstract] [Full Text]