Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE‐COARCT Study

Abstract

Background Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE‐COARCT (Long‐term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure ( BP ) phenotype by office BP , ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more‐distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long‐term studies are required to assess the clinical significance of the more‐optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 03262753.

Aortic elasticity after aortic coarctation relief: comparison of surgical and interventional therapy by cardiovascular magnetic resonance imaging

“…CMR studies after surgical CoA repair showed that even normotensive patients have an increased aortic stiffness and that this is associated with increased LV mass [8, 25, 28]. Our results are comparable with a recently published study which did not show significant differences for aortic stiffness parameters between CoA who were either treated with surgery, balloon dilatation or stent implantation [11]. Babu-Narayan et al, however, showed that adult patients after endovascular stenting have an increased aortic distensibility and they also showed reduced blood pressure indices, improved LVEF and reduced LV mass index [10].…”

“…Babu-Narayan et al has shown improved aortic distensibility after stenting [10]. Another recent study found no difference in aortic stiffness and endothelial function between CoA patients who were treated with surgery, balloon dilation, or stent implantation [11].…”

Diretrizes Brasileiras de Hipertensão Arterial – 2020

“…885 A resposta da PA ao tratamento intervencionista depende da duração da HA antes da cirurgia e da idade do paciente. 886 Embora muitos reduzam a PA após o procedimento invasivo, uma grande proporção desenvolve HA exercício induzida. Os medicamentos anti-hipertensivos de escolha tanto para o periodo pré-operatório quanto para a PA residual após a cirurgia são os betabloqueadores (BB) e os inibidores da enzima conversora de angiotensina (IECA) ou o bloqueador do receptor AT1 da angiotensina II (BRA).…”

Hypertension after coarctation repair—a systematic review

“…The remaining full texts were requested via our library, but only 4 published in English were used. After consulting the full content of these 356 articles, only 17 fulfilled the inclusion criteria as set out above (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) (Table 1).…”