Balloon angioplasty is preferred to surgery for aortic coarctation.

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.