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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: brian.mccrindle@sickkids.ca
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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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