Abstract
Background: Percutaneous stent placement has been shown to be a safe and effective treatment option for patients with coarctation of the aorta. Immediate post-procedural and short term hemodynamic assessments comparing stent placement to surgical correction show equivalency. Little is known about the effects of either treatment modality on blood pressure response during exercise. Methods: This study prospectively compares the hemodynamic response to exercise by treadmill testing in patients at least one year after intervention. Patients included were greater than seven years of age without complex congenital heart disease or single ventricle physiology. Patients underwent standard Bruce Protocol treadmill testing with periodic arm leg blood pressure and metabolic measurements. Results: Twenty-five patients underwent treadmill testing: 18 with surgical correction, 7 with stent placement. Median age was 13 years (IQR: 11-15.5yrs). The median arm-leg gradient prior to exercise was 12mmHg (IQR: 9.25-21.75mmHg) for surgical patients and 16mmHg (IQR: 3 - 25mmHg) for stented patients. The median peak exercise arm-leg gradient was 28mmHg (IQR:16 - 44mmHg) for surgical patients and 30mmHg (IQR:17.5 - 40mmHg) for stented patients. The median increase in the arm leg gradient with exercise was 16mmHg for surgical patients and 14mmHg for stented patients. Median Actual VO2Max/Predicted VO2Max was 100% for surgical patients compared to 96% for stented patients. Median Actual VO2Max/Predicted VO2Max was 100% for surgical patients compared to 96% for stented patients. Conclusions: Few studies have compared surgery and endovascular stenting for coarctation of the aorta, with only one prior study comparing the effects of exercise on blood pressure. Stenting and surgery offer excellent hemodynamic results acutely and at maximal exercise. Stent placement demonstrates equivalent results in blood pressure response during exercise testing when compared to surgical therapy.
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