Exercise Capacity Before and After Stent Placement for Coarctation of the Aorta: A Single-Center Case Series

Abstract

Over the last 15 years, stent placement has become a viable and safe alternative to surgical repair for native and recurrent coarctation of the aorta. Although patients with coarctation of the aorta often have lower exercise tolerance, there is no published data regarding the effect of coarctation stenting on exercise capacity. We aimed to determine the effect of coarctation stent placement on exercise capacity. We conducted a retrospective chart review of all patients who underwent stent placement for native or recurrent coarctation of the aorta at our institution from January 2000 to October 2012. We identified those patients who underwent exercise testing before and after stent placement. We compared measures of exercise capacity pre- and post-stent placement using paired t tests. Among 48 patients who underwent coarctation stenting, 7 (mean age = 40, range 21-65 years) were found to have isolated coarctation of the aorta and had the necessary pre- and post-stent exercise data. Only one patient had native coarctation of the aorta. The peak-to-peak systolic gradient improved by a mean of 26 mmHg (p < 0.02) after stent placement. Functional aerobic capacity (FAC) improved from a mean of 69-83% after stent placement (p < 0.03). Metabolic equivalents (METs) also improved significantly from a mean of 8.7 to 10.2 (p < 0.03). In our cohort, stent placement for relief of recurrent coarctation of the aorta resulted in a significant improvement in exercise capacity. This improvement may not be as significant in patients with milder coarctation of the aorta or those with complicating morbidities. Larger studies with more long-term follow-up are needed to better quantify this improvement and to define any lasting effect of this intervention on exercise tolerance.

Long-term observation of adults after successful repair of aortic coarctation

“…Most of them, despite the effective intervention, suffered from arterial hypertension. Data from the literature [33][34][35][36][37][38][39][40] demonstrate a decrease of arterial pressure after percutaneous intervention, although still higher values than in the healthy population. In our observation, patients with aortic recoarctation had more often concomitant hypoplastic aortic arch.…”

Anatomical/Physiological Correlates of Functional Capacity in Adults With Repaired and Nonsevere Coarctation of the Aorta

“… 10 It’s tempting to speculate on the value of identifying these patients, as prior studies demonstrate improvements in exercise capacity with stenting of mild-moderate coarctation. 24 , 25 Whether long-term cardiovascular morbidity is affected through this type of intervention remains to be seen, and future prospective studies on this population would help provide further understanding.…”

Asymptomatic Coarctation of the Aorta in Adults with Preserved Exercise Capacity

“…A few asymptomatic cases without other serious congenital heart diseases have been found incidentally during adulthood. However, untreated adult patients have a decreased exercise tolerance ( 1 ). Many adult patients with CoA cannot reach a normal exercise capacity, even after successful repair ( 2 ).…”