Medicine and Healthcare
Between Two and 18: Surgery or Catheterization?
New study looks at the best possible therapy for patients with coarctation of the aorta
Scientific name of the study
Arterial Hypertension and its Sequelae After Primary Treatment of Aortic Coarctation by Catheter Intervention versus Surgery: A Nationwide, Multi-Center, Long-term Study.
Aortic coarctation is one of the more common congenital heart defects. Approximately one in 3,000 to 4,000 newborns is affected by the narrowing of the aorta. This heart defect carries life-threatening risks. A narrowed aorta leads to increased blood pressure and strains the left ventricle as it has to work harder to pump oxygen-rich blood through the constriction.
In a newborn, the ductus arteriosus is still open. This is the important connection between the aorta and the pulmonary artery while the baby is in the womb. Shortly after birth, the ductus arteriosus closes on its own. In some children, however, it remains open. This is actually an advantage in cases of an interrupted aortic arch or severe aortic isthmus stenosis (aortic coarctation), as it ensures the supply of blood to the lower half of the body.
Risk to Heart and Brain
If a newborn has a severe constriction of the aorta or an interrupted aortic arch, his or her general condition deteriorates rapidly. Therefore, life-saving surgery is performed as soon as possible. If the stenosis is less severe, the heart defect is often not discovered until the patient is older. Apart from an unusual heart murmur that can be heard with a stethoscope, nothing else is noticeable at first. However, the narrowing of the aorta slowly changes the blood flow in the body. The result is high blood pressure in the upper half of the body, which can have long-term adverse effects on the heart, the blood vessels, and even the brain.
Different Treatment Standards
Today, aortic coarctation can be easily corrected. The goal is to prevent high blood pressure as a long-term complication. For newborns and children up to two years of age, surgery has become the standard of care. After opening the chest, the narrowing of the aorta is removed. Catheter intervention with stent implantation is a proven method for patients 18 years and older. A catheter is inserted and guided into the narrowed area of the aorta. The catheter has a small balloon at its tip that opens only at the narrowed area of the aorta and widens it. In addition, a tiny metal mesh over the balloon, called a stent, is inserted into the widened narrowing. It remains there to keep the aorta wide open.
Ensuring that Treatment is Age Appropriate
It is still unclear which correction method is most beneficial for infants over two years of age and for children and adolescents. That is why we are now investigating it in a nationwide long-term study. We are comparing the long-term outcomes after surgery and after a catheter intervention. We are retrospectively evaluating the course of the disease in participants in the National Registry who underwent one of the two procedures between the ages of two and 18. In this way, we can find out which of the two procedures is better at lowering blood pressure in the long-term and is therefore the more effective therapy.
Better Quality of Life
The results of our study should contribute to new treatment standards. The overall goal is to ensure an age-appropriate and sustainable procedure that is free of complications and thus improves patients' quality of life in the long-term.
In charge of the project:
Ulrike Bauer, born in 1958, is the Scientific Managing Director of the National Register for Congenital Heart Defects and the Competence Network for Congenital Heart Defects. More
Ulrike Bauer studied human medicine at the Humboldt University of Berlin. After finishing her doctorate on echocardiography in congenital heart disease, she was a resident for internal medicine at the county hospital in Chemnitz, after which she transferred to the Institute for Cardiovascular Diagnostics at the Charité Berlin. From there she transferred to the department of pediatric cardiology at the German Heart Center, Berlin (Deutsches Herzzentrum Berlin). Under the guidance of Prof. Dr. Peter E. Lange, Ulrike Bauer started setting up a nationwide register for congenital heart disease. The initiative by Prof. Dr. Peter E. Lange lead to the founding of the association of the National Register for Congenital Heart Defects. It was jointly supported by the board of trustees of Deutsches Herzzentrum Berlin and the cardiac societies, as well as by parent and patient associations. The same year was also the kick-off for creating the Competence Network for Congenital Heart Defects, which could took place thanks to government grants. Ulrike Bauer is a member of the German Society of Paediatric Cardiology (DGK), the European Society of Cardiology (ESC), the German Cardiac Society (DGK) and the Association for European Paediatric and Congenital Cardiology (AEPC).
Prof. Dr. med. Fabian Kari is a heart surgeon and senior physician at the European Children's Heart Center Munich. More
Fabian Alexander Kari studied medicine at the University of Freiburg from 2003 to 2010. From 2011 to 2018 he completed his specialist training as a cardiac surgeon at the Clinic for Cardiovascular Surgery in Freiburg and qualified as a specialist in 2018. For his doctoral thesis on neuroprotection in thoracic aortic repair ("summa cum laude"), he spent a year as a research fellow at the Mount Sinai School of Medicine (Cardiothoracic Large Animal Laboratory, Randall B. Griepp) in New York in 2007. After graduating from medical school in 2010, he completed a one-year clinical research fellowship at Stanford University focusing on functional results after valve-sparing aortic root surgery in the setting of hereditary connective tissue disease and congenital aortic valve disease (D. Craig Miller). In 2018, he trained in New York as a clinical fellow at Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, for subspecialization in pediatric cardiac surgery (Emile Bacha). Fabian Alexander Kari received the "venia legendi" (habilitation) for cardiac surgery in 2019. From 2019 to 2023 he worked as a cardiac surgeon at the University Heart Center Freiburg. Since 2023 he is a senior physician at the European Children's Heart Center Munich.