Management strategies in aortic coarctation

Fruh et al .( 1) report their data from a retrospective study of coarctations. The small number of patients in each group and the lopsided distribution of patients in each arm render statistical analysis meaningless. The data in the abstract are different from that in the text. (Abstract: Group A, B and C: n= 48/16/27. Results section: Group A, B and C: n= 48/17/26.) 'In the whole group 16 patients need reintervention. In the next paragraph, it appears 15 needed rein- tervention (12 natives + 3 recoarctation)'. The accuracy of this dataset is questionable. There is no data on resolution of hypertension in the various groups. Were the 24 recurrent coarctations, following surgery or cath- eter intervention? The authors state that the complication and reintevention rates are comparable between the three groups. The primary focus is supposedly a comparison of the modalities of treatment in each group—not a comparison of overall complication and reintervention rates between the three age groups, which could all be good or all be bad! This is not in line with the primary focus of the paper. 'In group C, stent implantation is an excellent alternative to surgery'. Do the authors recommend stent implantation as a primary modality or as 'an alternative to surgery'. In Group B, the reintervention rates for surgery vs catheter intervention (bal- loons + stents) in native coarctation were 0 vs 37.5%. In recoarc- tation, there were no catheter interventions at all, which precludes any comparison. Based on these data, how would the authors justify catheter intervention in Group B, as part of the protocol? The 37% incidence of recoarctation following catheter intervention, despite comparable acute reductions in gradients, indicates that an acute gradient reduction is an unreliable pre-