Background <p>Native coarctation of the aorta (CoA) accounts for 6–8% of congenital heart defects and poses significant morbidity and mortality risks if untreated. By incorporating the most recent evidence, focusing on the pediatric population, this protocol outlines the planned approach for a systematic review and meta-analysis update that will compare the long-term safety and effectiveness of surgical repair, balloon angioplasty, and stenting in CoA patients.</p> Methods <p>Following PRISMA guidelines, a systematic review and meta-analysis will be conducted. Electronic databases, including Scopus, LILACS, MEDLINE, CENTRAL, EMBASE, IBECS, OpenGrey, and major trial registries, will be searched for comparative studies of stent versus surgery and of balloon angioplasty versus surgery. Randomized control trials and observational studies focused on pediatric patients will be eligible. Two independent reviewers will screen the titles and abstracts based on predefined eligibility criteria, and two will assess the full texts of relevant studies. Quality assessment will be done with the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for observational studies. Pre-planned analyses, including quantitative and sensitivity analyses, are detailed within this protocol. R Studio will be used to analyze the data. The strength of the body of evidence will be assessed using GRADE.</p> Discussion <p>Despite recent advances in surgical and percutaneous techniques for CoA, there remains uncertainty on the best strategy for achieving long-term safety and effectiveness of treatment, particularly in the pediatric population. This study’s comprehensive comparative outcomes analysis will help bridge these gaps and inform clinical decision-making.</p> Systematic review registration <p>PROSPERO CRD42024549170. Registered on May 20th 2024.</p>