A systematic review and meta-analysis of outcomes of transcatheter stent implantation for the primary treatment of native coarctation

- There is a high success rate with a small complication rate with stent implantations for native CoA.
- The similar results are seen even as the treatment is brought to younger age group.
- Stent implantation may be superior to the other therapeutic alternatives for older patients.
- More data is needed on the feasibility and longer term results for the younger patients with CoA.

Background/objectivesThe treatment of native coarctation of aorta (CoA) has evolved since surgery performed in 1944, followed by transcatheter balloon angioplasty and recently, widely adopted stent implantation. Despite good results demonstrated with stent implantation, a systematic review and meta-analysis (SRMA) looking at the efficacy and safety of the intervention, particularly in younger population is yet to be done. We aimed to obtain pooled estimates of the success and complication rates after transcatheter stent implantation in the treatment of native CoA based on SRMA.MethodsWe searched literature published until 31 Dec. 2015, reporting outcomes of transcatheter stent implantation in the treatment of native CoA. The pooled estimates were obtained using the random effect model.ResultsSeventeen reports comprising 561 patients were included. Fourteen studies reported 100% success rate, the lowest was 77%, the largest study reported 81% using a definition of systolic pressure difference of less than 15 mm Hg. The pooled estimate of overall success rate was 98% (95% CI: 94.5-100.0; I2 = 65%, heterogeneity test p < 0.001). Six out of 17 studies reported zero complication. Two studies, however, reported complications in almost half of the cohort. The pooled estimate of rate of complications was 10% (95% CI: 5.1-15.5; I2 = 72%, heterogeneity test p < 0.001). Three studies comprising only children, 62, with mean age of 11.1 (4-19) years reported high mean success rate at 98% with only 1 failure.ConclusionsThere is a high success rate with a small complication rate with stent implantations for native CoA even as the treatment is brought to younger age group.