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Background Coarctation of aorta (CoA) accounts for 5–10% of all congenital heart defects. Despite &amp;gt;20 years of experience with balloon dilatation (BD) as an effective therapy, initial choice of procedure still remains controversial. Purpose This study was planned to identify the predictors of success of BD in native CoA and to evaluate immediate &amp; medium-term outcomes of the same. Methods This is a retrospective analysis of all BDs done over five years in a tertiary care centre. Success was defined as residual gradient ≤20 mmHg in the absence of a serious or life-threatening complication. In view of the high pre-dilatation gradient in many patients, a strict cut-off of 20 mmHg was not considered to be clinically feasible. Clinically acceptable outcome was thus defined as reduction of gradient to ≤20 mmHg or by ≥50% of baseline, to a final value ≤30 mmHg, in the absence of a serious or life-threatening complication. Repeat intervention on follow-up was considered in patients satisfying any of these criteria: symptoms attributed to CoA, significant residual gradient (&amp;gt;20 mmHg) with diastolic spill on echo, LV dysfunction, or refractory hypertension. Results Of the 111 cases analysed, 85 (76.5%) were male. The mean age was 11.79±12.64 years (1 month to 57 years). Bicuspid aortic valve was the most common associated anomaly, present in 42 (38%) patients. The mean gradient fell from 53.15±22.37 mmHg to 14.83±12.24 mmHg. Overall, the procedure was successful in 83 (74.8%) patients, and clinically acceptable outcome was obtained in 97 (87.4%) patients. Success rate and clinically acceptable outcome rate in the &amp;lt;18 years group was 80.7% (67/83) and 92.7% (77/83) respectively. Complications were seen in 9 (8.1%) cases. There was no mortality associated with the procedure. Ascending aortic pressure ≥150 mmHg [OR 27.94; 95% CI 1.30–598.84; p&amp;lt;0.001], and balloon to isthmus ratio &amp;lt;1 [OR 9.70; 95% CI 2.18–43.02; p&amp;lt;0.001] were significant negative predictors for success. At median follow-up of 43.5 months, reintervention free survival rate was 79.5% (62/78) in the overall group, and 81.5% (53/65) in the &amp;lt;18 years age group; with most of the repeat interventions being required within the first-year of the index procedure (14/16, 87.5%). Conclusion Immediate and medium-term success rates of BD in CoA are acceptable in majority of children and adolescents. High ascending aorta pressure and inadequate balloon size are important negative predictors of successful dilatation. Considering the economic advantages and reasonable success, balloon dilatation alone can be considered as a first line management option for native coarctation of aorta. Funding Acknowledgement Type of funding sources: None.

Immediate & medium-term results of balloon dilatation in native coarctation of aorta: a reasonable initial management strategy