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The management of coarctation of the aorta (COA) has evolved considerably since the initial surgical repair was described in 1945.1 Surgery is now invariably by an end-to-end anastomosis after excision of the coarctation segment and in neonates and infants is often extended to address coexistent aortic arch hypoplasia.2 While surgery was evolving, catheter intervention also developed and beyond the first 6–12 months of age became routine treatment in many (though not all) centres.3 Catheter intervention, in addition to being used for primary treatment, is also used to correct residual defects (both stenotic and aneurysmal) from earlier surgery or catheter procedures.4 5 Many patients considered to be “repaired” according to criteria established in the early surgical era are now found to have residual defects with modern tomographic imaging or have residual hypertension that requires treatment.6 7
Catheter intervention with balloon dilatation for re-coarctation in the 1980s evolved to balloon dilatation for native coarctation in a limited number of centres, but with the advent of endovascular stenting in the 1990s and covered stent implantation in the 2000s is increasingly becoming the approach of choice.8 9 As with many other developments in congenital heart disease, this changing approach was never compared to surgery (which was also constantly evolving) in randomised trials. Thus the true value of coarctation stenting can only be judged by publication of large series with extended clinical follow-up.
Chakrabarti et al present a large single centre study of coarctation stenting in 88 patients over a 6-year period in this issue of Heart (see page 1212).10 As with many smaller series, the results are excellent. Gradients across the coarctation segment were reduced and blood pressure control improved with a low rate of acute complications (one patient required emergency surgery for aortic rupture). While follow-up …