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Rationale and design of long-term outcomes and vascular evaluation after successful coarctation of the aorta treatment study


1 Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
2 Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, USA
3 Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, USA
4 Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, USA
5 Joint Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska College of Medicine, Omaha, USA
6 Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
7 CEDOC Chronic Diseases, Nova Medical School, Lisbon, Portugal
8 Caselas, Ressonância Magnética, S. A. Lisbon, Portugal
9 Biomedical Engineering Department, Instituto Superior Técnico, Lisbon, Portugal

Correspondence Address:
Dr. Jose D Martins
Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Rua de Santa Marta, 50, 1150-024, Lisbon
Portugal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_64_18

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Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 282-296

 

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Background: Coarctation of the aorta (CoA) can be treated using surgery, balloon angioplasty, or stent implantation. Although short-term results are excellent with all three treatment modalities, long-term cardiovascular (CV) morbidity and mortality remain high, likely due to persistently abnormal vascular function. The effects of treatment modality on long-term vascular function remain uncharacterized. The goal of this study is to assess vascular function in this patient population for comparison among the treatment modalities. Methods: We will prospectively assess vascular Afunction in large and small arteries fusing multiple noninvasive modalities and compare the results among the three groups of CoA patients previously treated using surgery, balloon angioplasty, or stent implantation after frequency matching for confounding variables. A comprehensive vascular function assessment protocol has been created to be used in 7 centers. Our primary outcome is arterial stiffness measured by arterial tonometry. Inclusion and exclusion criteria have been carefully established after consideration of several potential confounders. Sample size has been calculated for the primary outcome variable. Conclusion: Treatment modalities for CoA may have distinct impact on large and small arterial vascular function. The results of this study will help identify the treatment modality that is associated with the most optimal level of vascular function, which, in the long term, may reduce CV risk.






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1 Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
2 Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, USA
3 Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, USA
4 Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, USA
5 Joint Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska College of Medicine, Omaha, USA
6 Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
7 CEDOC Chronic Diseases, Nova Medical School, Lisbon, Portugal
8 Caselas, Ressonância Magnética, S. A. Lisbon, Portugal
9 Biomedical Engineering Department, Instituto Superior Técnico, Lisbon, Portugal

Correspondence Address:
Dr. Jose D Martins
Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Rua de Santa Marta, 50, 1150-024, Lisbon
Portugal
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_64_18

Rights and Permissions

Background: Coarctation of the aorta (CoA) can be treated using surgery, balloon angioplasty, or stent implantation. Although short-term results are excellent with all three treatment modalities, long-term cardiovascular (CV) morbidity and mortality remain high, likely due to persistently abnormal vascular function. The effects of treatment modality on long-term vascular function remain uncharacterized. The goal of this study is to assess vascular function in this patient population for comparison among the treatment modalities. Methods: We will prospectively assess vascular Afunction in large and small arteries fusing multiple noninvasive modalities and compare the results among the three groups of CoA patients previously treated using surgery, balloon angioplasty, or stent implantation after frequency matching for confounding variables. A comprehensive vascular function assessment protocol has been created to be used in 7 centers. Our primary outcome is arterial stiffness measured by arterial tonometry. Inclusion and exclusion criteria have been carefully established after consideration of several potential confounders. Sample size has been calculated for the primary outcome variable. Conclusion: Treatment modalities for CoA may have distinct impact on large and small arterial vascular function. The results of this study will help identify the treatment modality that is associated with the most optimal level of vascular function, which, in the long term, may reduce CV risk.






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