Abstract 1934: Predictors of Long-Term Success Following Balloon Angioplasty of Native Coarctation
BACKGROUND: Balloon angioplasty (BA) of native coarctation (CoA) is an accepted therapy, however, long-term results and predictors of success are limited.
OBJECTIVES: To examine the long-term outcomes of subjects ≤ 20 yrs of age undergoing BA for native CoA, and factors predicting freedom from reintervention.
METHODS: Retrospective study of subjects aged 6 mos to 20 yrs (6.5 ± 4 yrs) who underwent BA of native CoA between 1983 and 1998.
RESULTS: Of 114 patients undergoing BA, follow-up data were available for 101. At catheterization, the baseline systolic gradient was 43.0 ± 15 mmHg, decreasing to 10.5 ± 10 mmHg following BA (p < 0.0001). There were no deaths. Four patients had no change in their gradient. Serious complications included intimal tear or aneurysm formation (n = 11), diminished femoral pulses (n = 11), and stroke (n = 3). Of the 114 pts, 13 (11%) were lost to F/U. Sixty-nine (68%) were free from reintervention during their follow-up period (9 ± 5.3 yrs, range 1–21 yrs) (NO-INT group). Their gradient at catherization following BA was 7.5 ± 8 mmHg. Thirty-two patients (31%) required either surgical or catheter reintervention following BA (RE-INT group). The time to reintervention ranged between 0 to 18.7 yrs (mean 5.8 ± 5 yrs). Their gradient at catheterization following BA was 17 ± 10 mmHg. Comparison between NO-INT and RE-INT groups revealed no difference in age (p = 0.15) or weight (p = 0.56) at catheterization, but revealed a statistically significant difference in immediate residual gradient (NO-INT: 7.5 ± 8 mmHg, RE-INT: 17 ± 10 mmHg, p < 0.0001). At the last documented visit, the average arm to leg blood pressure gradient by sphygmomanometry in NO-INT remained stable (5.8 ± 9 mmHg, p = 0.18). ROC analysis demonstrated that an immediate residual gradient ≤ 12 mmHg predicted freedom from reintervention with the greatest sensitivity and specificity (AUC 0.74). For this population, a residual gradient of ≤ 12 mmHg yielded a positive predictive value of 80% and negative predictive value of 72% for freedom from reintervention.
CONCLUSION: BA of native CoA is an effective therapy in subjects ≤ 20 yrs of age. A residual gradient at catheterization of ≤ 12 mmHg is predictive of freedom from reintervention.