Morrical Brandon D, Anderson Jason H, Taggart Nathaniel W
Department of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.
Pediatr Cardiol. 2017 Aug;38(6):1143-1147. doi: 10.1007/s00246-017-1628-3. Epub 2017 May 18.
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.
在过去15年中，对于原发性和复发性主动脉缩窄，支架置入已成为一种可行且安全的手术修复替代方法。虽然主动脉缩窄患者的运动耐量通常较低，但尚无关于主动脉缩窄支架置入对运动能力影响的公开数据。我们旨在确定主动脉缩窄支架置入对运动能力的影响。我们对2000年1月至2012年10月在本机构接受原发性或复发性主动脉缩窄支架置入的所有患者进行了回顾性病历审查。我们确定了那些在支架置入前后接受运动测试的患者。我们使用配对t检验比较了支架置入前后的运动能力指标。在48例接受主动脉缩窄支架置入的患者中，7例（平均年龄 = 40岁，范围21 - 65岁）被发现患有孤立性主动脉缩窄，并有必要的支架置入前后运动数据。只有1例患者患有原发性主动脉缩窄。支架置入后，峰 - 峰收缩期压差平均改善了26 mmHg（p < 0.02）。功能性有氧能力（FAC）从平均69%提高到83%（p < 0.03）。代谢当量（METs）也从平均8.7显著提高到10.2（p < 0.03）。在我们的队列中，置入支架以缓解复发性主动脉缩窄导致运动能力显著改善。对于主动脉缩窄较轻或有合并症的患者，这种改善可能不那么显著。需要进行更大规模、更长期随访的研究，以更好地量化这种改善，并确定这种干预对运动耐量的任何持久影响。
