Table S1 Characteristics of Included Studies Study and Quality of Evidence Population Resting Hypertension Cardiac Abnormalities Treatments Physical Activity Description of Exercise Exercise Hypertension Agnoletti et al., Grade: 3A Quality: 10 N = 8 Adults and 7 Children 7-29 years Mean 17 years N = 8 5 treatment VSD, N = 3 of Great Arteries, N = 1 8 Direct suture 9 Extended Reconstruction 3 Banding of Pulmonary Trunk 3 De-banding 2 VSD Closure 1 Synthetic Patch 1 Arterial Switch Operation Not reported 30 Exercise stress tests 15 15 Mean 22 months post-surgery Treadmill Bruce protocol Exercise terminated: 1 claudication of legs, 2 exercise 2 SBP >270 mmHg 7 SBP >250 mmHg 9 “Mild” 5 “Severe” 3 adults SBP >250 mmHg 13 children SBP >95th Balderston et al., 19923 3A Quality: 9 N = 31 Children 7-17 years Mean 11 years “usually normal” Resting SBP 111 ± 4.7 mmHg Aortic N = 24 Aortic with VSD or AS, N = 7 8 Subclavian Flap Repair 21 End to End Anastomosis 1 Patch Aortoplasty 1 Tubular Graft 6 Recurrent Obstruction Repair 4 Aortic or SubAS Repair VO2max 48 ± 1 27 Exercise stress tests Mean 93 months post-surgery Treadmill Bruce protocol N = 6 percentile on
Banaszak et al., 20094 Grade: 3A Quality: 10 N = 29 Children 4-17 years Mean 12 years Not reported Aortic alone Surgical repair of Aortic Coarctation Not reported 29 Exercise stress tests Minimum 1 year Treadmill protocol Max HR 169 Exercise terminated: 1 exercise 8 fatigue, 20 submaximal target HR 5 SBP >200 mmHg et al., 20015 Grade: 3A Quality: 8 N = 15 12 Male Adults 50-63 Years Mean 54 years 3 mild 5 AS 4 CAD 3 BAV 2 AI 2 MI 1 VSD 13 Prosthetic bypass 2 Aortoplasty Not reported 11 Exercise stress tests 0.5-11.5 years Mean 4 years Cycle ergometer Exercise terminated: 1 dyspnea, 1 muscle weakness 8 exercise SBP >195 mmHg 0 SBP>250 mmHg 0 DBP >115 mmHg on surgery
Brown et al., 20106 Grade: 3A Quality: 13 N = 95 of 528 Children 1 years Mean 1.9 days Not available among Aortic Coarctation subgroup 528 congenital AS 528 Balloon aortic valvuloplasty 71 Coarctation or interrupted aortic arch surgical repair 43% Exercise No exercise sessions observed No exercise sessions observed Buys et al., 20137 Grade: 3A Quality: 13 N = 103 70 Male Adults 18-50 Mean 28.7 ± 6.3 years 29 treatment Excluded if additional cardiac defects 41 Patch aortoplasty 36 Resection and End to End Anastomisis 14 Subclavian flap aortoplasty 7 Balloon dilation with stenting 2 Resection and tube graft 2 Extensive arch patch reconstruction 1 Extra anatomic bypass 50% 31% Active or Active, 19% Active Mean 0.12 sports activity, 9 activity VO2max 30.0 ± 7.1 103 Exercise stress Cycle ergometer Graded protocol Mean 9.48 min/test Max HR 172 ± 18 beats/min Exercise terminated: fatigue of legs or shortness of breath No adverse events Not reported on
Carano et al., 19998 Grade: 3A Quality: 10 N = 9 adults, 19 children 18 Male Adults and Children 9-22 years Mean 15 years N = 9 5 mild transverse aortic arch hypoplasia 3 mild residual 16 Anastomosis 7 aortoplasty 4 Subclavian flap surgery 1 Graft aortoplasty Not reported 28 Exercise stress tests Cycle ergometer Graded protocol 16 Exercise 0 adult SBP >250 mmHg 8 children SBP >95th Carpenter et al., 19859 3A Quality: 12 N = 32 18 Male 22 Adults, 10 Children 7-59 Mean 24.9 ± 12.4 N = 5 13 BAV 9 Eccentric aortic valve Excluded if additional cardiac defects End to end anastomosis, aortoplasty or subclavian pulldown Not reported 32 Exercise stress tests 2-27 years mean 15 years Cycle ergometer Graded protocol Max HR 139 ± 23 beats/min Adverse events not reported Not reported Connor and Baker, 198110 Grade: 3A N = 3 adults N = 2 Not reported 18 End to end Anastomosis Not reported 31 Exercise stress tests 0 SBP >250 mmHg percentile
Adverse events not reported Cumming and Mir, 197013 Grade: 3A Quality: 10 N = 2 adults and 6 children 7 Male 2 Adults, 6 Children 9-24 years Mean 14 ± 5 years N = 5 Not reported Not reported VO2max 325 ± 117 kpm 16 Exercise stress tests 6 1 post-surgery Cycle ergometer Graded protocol Max HR 138 ± 11 beats/min 0 SBP >250 mmHg or DBP >115 mmHg 6 Children SBP >95th Cyran et al., 199314 Grade: 3A Quality: 12 N = 1 adult, 23 children 15 Male Children 5-19 Mean 10.3 ± 3.8 years N = 5 15 BAV 2 mild AS 1 VSD 17 Subclavian flap angioplasty 6 End to end anastomosis 2 VSD closure 1 Synthetic patch aortoplasty 1 Aortic valvotomy Not reported 24 Exercise stress tests 8.0 ± 3.8 years Treadmill Bruce protocol Mean 13.7 min/test Max HR 92.1% ± 6.2% Predicted N = 7 children 95th Dahlback et al. 196415 3A Quality: 9 N = 10 of 12, 9 adults N = 9 2 aortic valve stenosis 1 aortic valve 1 Incomplete operation for coarctation Not reported 10 Exercise stress tests Supine Cycle Ergometer 3 adult SBP >250 mmHg percentile percentile
and 1 youth 7 Male Adults 16-51 years Mean 32.2 ± 14.7 years Graded protocol 6 min stages Max HR 129 ± 16.4 4 Exercise (1 youth) 1 adult DBP >115 mmHg 1 youth SBP >95th Das et al., 200916 Grade: 3A Quality: 13 N = 27 18 Male Children 8-18 Mean 14 ± 3 years N = 23 Isolated aortic Excision and end to end anastomosis Left subclavian flap repair Not reported 27 Exercise stress tests 2-6 years post-surgery Treadmill Bruce protocol 11 SBP >95th for body surface area De Caro et al., 200717 Grade: 3A Quality: 11 N = 41 28 Male Adults and Children 9-30 years Mean 15.7 ± 4.6 years N = 8 4 treatment No associated complex congenital heart defects 25 Subclavian flap aortoplasty 8 Patch aortoplasty 6 end to end anastomosis 4 Balloon dilation 2 Stent implantation Not reported 41 Exercise stress tests 15.3 ± 4.4 years Cycle ergometer Graded protocol Max HR 168 ± 16 beats/min Exercise terminated: all exhaustion N = 24 percentile
6-30 years Mean 13.7 min/test Max HR 191.3-192.4 ± 1.8-2.8 beats/min 1 ST Segment Depression Fripp et al., 198321 Grade: 3A Quality: 10 N = 8 of 20 Children Mean 4.6 years N = 4 at 50th for height as per National High Blood Pressure 200422 Not reported 8 Subclavian flap aortoplasty Not reported 8 Exercise stress tests Minimum 3 years Treadmill Bruce protocol Mean 9.2 min/test Max HR 177 ± 12 beats/min No adverse events None Gi et al., 200723 Grade: 3A Quality: 11 N = 11 of 48 30 of 48 Male Children Mean 11.8 ± 3.5 years 3 treatment CHD Repair for coarctation of aorta (unspecified) VO2max 33.3 ± 6.1 11 Exercise stress tests Mean 10.6 Treadmill Ohuchi Protocol Mean 8.7 min/test Not reported percentile on on
Max HR 173.7 ± 19.8 beats/min 1 ventricular tachycardia at peak exercise Giardini et al., 200724 Grade: 3A Quality: 11 N = 34 20 Male Adults and Children 11-44 Mean 24 ± 7 years N = 3 14 BAV 3 VSD 34 End to end anastomosis 7 Percutaneous balloon angioplasty 1 Stent implantation Not reported 34 Exercise stress tests 15.3 ± 4.6 years ergometer Graded protocol Mean 8 min/test Max HR 166 ± 18 beats/min 18 SBP ≥200 mmHg Giordano et al., 200525 Grade: 3A Quality: 10 N = 43 Children Mean 13-14 ± 2.6-3.9 years 0 treatment Not reported 22 Construction of subclavian flap 21 End to end anastomosis VO2max Range 115-135 ± 35-45 Watts 43 Exercise stress tests Mean 13.2 years Cycle ergometer James Protocol 23 Abnormal SBP response
Mean 8.7 min/test Max HR 167-168 ± 14-18 Goldberg et al., 196926 Grade: 3A Quality: 10 N = 14 of 312 Children Not reported Not reported Not reported Not reported 14 Exercise stress tests Cycle ergometer Graded protocol Adverse events not reported Not reported Guenthard et al., 199627 3A Quality: 8 N = 36 Adults and Children 13-35 Mean 23 years 0 treatment BAV and mild stenosis included, no cardiac Coarctation resection (unspecified) VO2max 161 Watts 36 Exercise stress tests Mean 17 years Cycle ergometer James Protocol Mean 13 min/test Max HR 161 beats/min 27 SBP >225 mmHg male or >210 mmHg female Hager et al., 200828 Grade: 3A Quality: 13 N = 260 176 Male Adults Not reported Isolated aortic 192 End to end anastomosis and resection 58 Tube graft interposition and resection VO2max 180 ± 52 Watts 260 Exercise stress tests Cycle ergometer Graded protocol 73 SBP >2 SD above reference value
Mean 30.2 ± 11.4 4 aortoplasty 3 Subclavian flap aortoplasty 1 Direct aortoplasty 1 Subclavian-aortic anastomosis 1 bypass Hanson and Ericksson, 198029 Grade: 3A Quality: 12 N = 19 19 Male Adults and Children 16-28 years Mean 21 years Not reported 11 Persistent ductus arteriosus 1 slight mitral stenosis with slight aortic 1 slight mitral 19 End to end anastomosis VO2max 197 Watts 19 Exercise stress tests Mean 11 years Cycle ergometer Graded protocol Mean 21.5 min/test Max HR 191 ± 6.6 beats/min 11 elevated SBP Harris et al., 201530 Grade: 3A Quality: 3 N = 2 of 44 Not reported Not reported Not reported All Athletes No exercise sessions observed Reported Sudden Athlete Death Not reported Hauser et al., 200031 Grade: 3A Quality: 10 N = 55 44 Male Children N = 25 0 29 BAV 31 Subclavian flap aortoplasty 16 End to end anastomosis VO2max 51.4 ± 11.7 55 Exercise stress 8 SBP >95th
4-45 Mean 14 years not reported heart failure 2 Patent ductus arteriosus 1 Septic emboli due to aortitis 1 Hypopastic aortic arch and left subclavian stenosis 1 Peripheral pulmonary stenosis 1 Aortic valve stenosis and mitral 1 Aneurysm of sinus of Valsalva 1 Parachute deformity of mitral 9 Graft interposition and resection 8 Patch graft angioplasty 1 Subclavian artery to descending aorta bypass raft Cycle ergometer Submaximal Protocol Mean 6 min/test Adverse events not reported
1 Aortic valve stenosis 1 origin of right subclavian et al., 199036 Grade: 3A Quality: 10 N = 7 Adults and 3 children Mean 18 years N = 2 Isolated aortic Not reported Not reported 20 Exercise stress Treadmill Modified Bruce protocol 10 SBP ≥220 mmHg pre-sugery 9 SBP >95th 1 adult SBP >250 mmHg 4 child SBP >95th Kimball et al., 198637 3A Quality: 11 N = 25 16 Male Adults 18-41 years Mean 26.1 years 2 treatment Excluded congenital disease 18 BAV 4 Minimal aortic 10 Subclavian flap aortoplasty 6 Synthetic patch aortoplasty 5 End to end anastomosis 4 Aortic interposition grafting Not reported 25 Exercise stress tests Mean 10.6 years Cycle ergometer Graded protocol Not reported percentile
Max HR 147.7 ± 25.8 beats/min Adverse events not reported Kimball et al., 199438 Grade: 3A Quality: 12 N = 4 Adults and 26 Children 19 Male Mean 7.5 ± 3 years 16 SBP above 95th 24 SBP above 90th 0 coexisting heart disease 11 Patch angioplasty 10 End to end anastomosis 8 Subclavian flap angioplasty 1 Primary balloon angioplasty Not reported 30 Exercise stress tests 7.5 ± 3 years post-surgery Cycle ergometer Graded protocol 0 Adult SBP >250 mmHg 16 children SBP >95th Kimball et al., 198639 Grade: 3A Quality: 10 N = 27 18 Male Adults 19-41 years Mean 26 years Not reported Excluded congenital cardiac lesions including valvular disease associated with BAV Direct anastomosis Tubular interposition graft aortoplasty Left subclavian flap angioplasty Not reported 27 Exercise stress 2-25 years post-surgery Treadmill Bruce protocol Mean 12 min/test Max HR 170 beats/min No adverse events None Krieger et al., 201340 Grade: 3A Quality: 13 N = 47 24 Male Adults 17-37 years Mean 25.5 27 treatment Excluded complex congenital heart disease, aortic 17 End to end anatomostasis 7 Patch aortoplasty 7 Angioplasty with stent replacement 5 Subclavian flap repair VO2max 29 ± 8 47 Exercise stress tests Treadmill Bruce protocol 11 SBP >220 mmHg percentile
arch or aortic valve 3 Angioplasty without stent placement 2 Conduit placement 6 Unidentified operative strategy Larsen et al., 200341 Grade: 3A Quality: 11 N = 51 24 Male Adults and Children 6-67 Mean 28 years N = 25 21 BAV 12 arch 22 End to end anastomosis 17 Extended resection 5 Subclavian flap angioplasty 7 Miscellaneous procedures Not reported 51 Exercise stress tests Treadmill 8 SBP >220 mmHg Leandro et al., 199242 Grade: 3A Quality: 12 N = 20 13 Male Children 11-19 years Mean 14.4 ± 3 N = 0 Excluded cardiac lesions or evidence of No cardiac 14 End to end anastomosis 3 Subclavian flap 1 Dacron patch 1 Subclavian flap and Dacron patch 1 Subclavian flap and end to end anastomosis Not reported 20 Exercise stress tests 9.2 ± 3.1 years Treadmill protocol Mean 10.6 min/test Max HR 189 ± 18 beats/min Adverse events not reported Not reported Li et al., 201543 3A N = 15 of 18 Not reported 6 BAV 1 Thin 22 Balloon angioplasty Not reported 15 Exercise stress tests Not reported
Quality: 12 7 of 18 Male Adults Mean 24.2 ± 5.4 years subaortic membrane 7 Ligation of patent ductus arteriosus 5 VSD closures 1 ASD closure Cycle ergometer Graded protocol Max HR 134 ± 5 beats/min Adverse events not reported Logan et al. 195844 3A Quality: 10 N = 9 of 169 Adults Not reported Not reported Not reported Not reported 9 Exercise stress tests Treadmill 1.7 miles per hour at 10% grade up to 10 min 2 Exertional <10% increase in SBP 2 Exercise during recovery >15 mmHg increase from exercise Madueme et al., 201345 Grade: 3A Quality: 12 N = 38 30 Male Adults and Children 7-21 years Mean 12.7 ± 3.9 years 11 0 treatment Excluded congenital cardiac lesions 29 BAV 38 end to end anastomosis VO2max 40 ± 6 38 Exercise stress tests Cycle ergometer James Protocol Max HR 189 ± 9 beats/min 6 SBP >95th on
Malan et al., 199146 Grade: 3A Quality: 13 N = 95 Children 3-11 N = 16 4 2 Aneurysm 95 Patch angioplasty 5 End to end anastomosis 4 Subclavian flap angioplasty 1 Tube bypass graft Not reported 15 Exercise stress tests 7.4 ± 1.6 Cycle ergometer Protocol No adverse events Not reported Markel et al., 198647 Grade: 3A Quality: 10 N = 28 21 Male Children 8-20 years Mean 1 13.8 ± 2.8 years 0 treatment No significant associated cardiac anomalies 14 End to end anastomosis and excision 14 Patch angioplasty VO2max 42 ± 8 56 Exercise stress tests 4.1 ± 3.7 Treadmill Bruce and Faraday Protocols Mean 14.1 min/test Max HR 186 ± 17 beats/min Adverse events not reported N = 13 Markham et al., 200448 Grade: 3A Quality: 12 N = 25 16 Male Children Mean 14.2 ± 3.8 0 treatment 12 BAV 10 Trivial to mild aortic stenosis 19 End to end anastomosis 3 Intra-aortic balloon angioplasty 1 Subclavian flap angioplasty VO2max 38.3 ± 6.8 25 Exercise stress tests Cycle ergometer James Protocol Not reported
6 Trivial to mild aortic 4 Small VSD 2 Mild mitral 1 Small ASD 1 Gortex patch 1 Intra-aortic stent placement Max HR 186.2 ± 11.9 beats/min No adverse events Menting et al. 201549 Grade: 3A Quality: 14 N = 5 of 91 56 of 91 Male Adults 35-43 years Mean 39.6 years Not reported 91 VSD 80 VSD closure with patch VO2max 87% ± 20% 5 Exercise stress tests Mean 36.7 years Cycle ergometer Graded protocol Adverse events not reported Not reported Murphy et al., 198950 Grade: 3A Quality: 11 N = 21 19 Male Children 4-17 years Mean 8.8 ± 9.4 years 21 SBP ≥95th 13 DBP ≥95th No associated defects Not reported Not reported 42 Exercise stress tests 21 21 mean 31 months post-surgery ergometer 1 SBP >260 mmHg 4 SBP >200 mmHg 3 SBP >200 mmHg surgery
21 SBP ≥95th 3 DBP ≥95th Graded protocol Max HR 173 ± 22 beats/min 2 Exercise Elevated Systolic Pressure Norozi et al., 200551 Grade: 3A Quality: 11 N = 28 of 52 18 Male Children 4-11 years mean 7.9 ± 2.2 years N = 0 NYHA I 28 End to end anastomosis VO2max 72 Watts No of physical activity Physical activity not cause undue fatigue, or dyspnea 28 Exercise stress tests Mean 7 years Cycle ergometer Graded protocol Mean 9.5 min/test Max HR 173 beats/min Adverse events not reported Not reported Ntsinjana et al., 201352 Grade: 3A Quality: 11 N = 20 of 40 7 Adult and 13 Children 16 Male N = 5 at 50th percentile for height as per National High Blood 20 ‘Gothic’ aortic arch Not reported VO2max 33.9 ± 8 20 Exercise stress Mean 15 ergometer 4 children SBP >95th
Mean 16.5 ± 2.1 years Pressure 200422 Graded protocol Max HR 168 ± 22 beats/min 9 Exercise Ou et al., 200653 3A Quality: 12 N = 75 Children Mean 15 ± 5.8 years N = 0 No significant associated cardiac anomalies 43 Standard end to end anastomosis 32 Extended end to end anastomosis Not reported 75 Exercise stress tests Mean 15 years Treadmill Bruce protocol 35 SBP ≥95th percentile or 210 mmHg men or 190 mmHg Oyen et al., 198754 Grade: 3A Quality: 9 N = 9 of 35 22 of 35 Male Children 6-14 years Not reported 6 Mild 3 Severe 8 NYHA I 1 NYHA II Not reported Not reported 9 Exercise stress tests ergometer Graded protocol No adverse events Not reported Pedersen et al., 201155 Grade: 3A Quality: 12 N = 133 84 Male Adults 26-74 Mean 44 years N = 75 49 treatment 63 BAV 45 aortic valve 28 Ascending aorta aneurysm 93 End to end anastomosis 27 Prosthetic material 2 Subclavian flap angioplasty 11 Unknown coarctation repair 16 Aortic valve prosthesis Not reported 116 Exercise stress tests Mean 34 Cycle ergometer 43 SBP ≥220 mmHg
treatment and 13 at 6 months post-surgery Treadmill Bruce protocol Mean 10.9 min/test Max HR 200 ± 7.5 beats/min Rampton et al., 197758 Grade: 4B Quality: 6 N = 1 Male 46 years N = 1 Partial right bundle branch block Left ventricular T wave inversions in leads I, aVL and V Calcified aortic None Not reported 5 Exercise stress Pre-surgery Cycle ergometer Graded protocol Mean 14.8 min/test Max HR 180 beats/min No adverse events 0 SBP >220 mmHg 0 DBP >115 mmHg Rhodes et al., 199759 Grade: 3A Quality: 11 N = 15 9 Male Adults and Children 10-32 years N = 0 0 treatment Isolated aortic 0 other recognized medical problems Not reported VO2max 29.6 ± 8.1 Engage in normal, 15 Exercise stress tests Mean 14 years Cycle ergometer Not reported
Mean 19 ± 7 years physical activities without Graded protocol Max HR 182 ± 11 No adverse events Salzer-Muhar et al., 198760 Grade: 3A Quality: 11 N = 46 29 Male Adults and Children 0-23 years N = 7 12 Persistent ductus arteriosus 5 Persistent ductus arteriosus and VSD 2 Aortic stenosis 1 Aortic valve 1 Subaortic stenosis 1 VSD 1 ASD 1 persistent ductus arteriosus 46 End to end anastomosis and resection Not reported 46 Exercise stress tests Mean 6 years Treadmill protocol Adverse events not reported 4 SBP ≥200 mmHg
and aortic stenosis 1 Persistent ductus arteriosus and aberrant left coronary artery 1 VSD and mitral Sehested et al., 198361 Grade: 3A Quality: 10 N = 12 6 Male 9 Adults and 3 Children 14-33 Mean 21.5 years 9 3 Isolated aortic Normal cardiac function Not reported VO2max 532.5 kg∙min-1 24 Exercise stress tests 12 12 Mean 204 days post-surgery ergometer Submaximal Protocol Mean 20 min/test Max HR 155 ± 18 beats/min 3 Adult SBP >250 mmHg 2 Children SBP >95th Sigurdardottir and N = 27 16 Male Children 0 Good health, Not reported Not reported 27 Exercise stress tests 4 SBP ≥210 mmHg
Grade: 3A Quality: 12 6-21 Mean 14.6 ± 0.8 years treatment symptom free 27 Treadmill protocol Mean 13.9 min/test Max HR 190 ± 3 beats/min Swan et al.,200363 Grade: 3B Quality: 10 N = 56 33 Male Mean 29.8 ± 11 years N = 12 8 treatment 37 BAV 1 Angina 30 End to end anastomosis 7 Patch grafting 6 Subclavian flap repair 6 Catheter procedure 10 Surgical repairs redone for recoarctation or aneurysm Not reported 56 Exercise stress tests Mean 21 Treadmill Bruce protocol Max HR 176.9 ± 17.4 beats/min 7 SBP ≥230 mmHg Tancredi et al., 201164 Grade: 3A Quality: 11 N = 2 of 50 0 Male 7-39 years Mean 21.3 ± 8.5 years N = 0 0 treatment 50 Turner syndrome Not reported 1.6 ± 0.9 activity VO2max 28.4 ± 4 2 Exercise stress tests Treadmill Bruce protocol Mean 9.1 min/test Max HR 184.8 ± 12.9 beats/min 16 6 pain Not reported 62
in legs, unspecified among aortic coarctation subgroup Tantengco et al., 199765 Grade: 3A Quality: 12 N = 50 38 Male Mean 17 ± 6.7 years Not reported No aortic valve stenosis, aortic or mitral valve or residual VSD 43 End to end anastomosis 4 Subclavian flap angioplasty 3 Patch angioplasty Not reported 50 Exercise stress Median 9.5 years Cycle ergometer Graded protocol 18 SBP >2 SD from norms as per Alpert et al. 198266 Taylor et al. 196067 Grade: 3A Quality: 9 N = 20 11 Male Adults and 15-37 years Mean 24 years N = 18 12 moderate LV 6 reduced LV 12 12 surgical repairs for coarctation VO2 698.8 ± 201.8 32 Exercise stress tests Supine cycle Ergometer 5 min each for 1-3 stages Max HR 148.6 ± 20.9 beats/min 6 Exercise 8 Adult SBP >250 mmHg 7 Children SBP >95th et al., 199168 3A Quality: 9 N = 16 13 Male Adults 20-55 years Not reported Not reported 16 End to end anastomosis and resection Not reported 16 Exercise stress ergometer Not reported
Mean 30 years Adverse events not reported Therrien et al., 200069 Grade: 3A Quality: 9 N = 84 44 Male Adults 18-64 years Mean 30.2 30 treatment Isolated aortic 13 and VSD 9 Complex aortic 10 Aneurysm 40 End to end anastomosis 16 Onlay Dacron patch 10 Internal mammary artery aortoplasty 9 Interposition graft 5 Bypass 4 Balloon angioplasty 1 Subclavian flap angioplasty Not reported 84 Exercise stress tests 16.2 ± 10.1 years Adverse events not reported Not reported Trojnarska et al., 200770 Grade: 3A Quality: 12 N = 74 45 Male Adults 19-61 years Mean 31.2 ± 9.8 years N = 42 NYHA I 6 VSD 5 Occluded persistent arterial duct 19 Trivial mitral 65 Synthetic patch repair 6 End to end anastomosis 3 Subclavian flap aortoplasty 1 Noninvasive recoarctation repair 1 Stent graft implantation in ascending aorta VO2max 26.77 ± 6.75 74 Exercise stress tests 21.4 ± 6.2 years Treadmill Modified Bruce protocol Max HR 167.9 ± 21.2 beats/min 10 SBP >200 mmHg Vriend et al., 200471 Grade: 3A Quality: 13 N = 144 91 Male Mean 31.5 ± 11.2 years N = 59 27 treatment 19 VSD 15 Patent arterial duct 11 Left ventricular 103 End to end anastomosis 17 Patch angioplasty 13 Subclavian flap aortoplasty Not reported 144 Exercise stress tests Mean 23 years Treadmill 38 SBP >200 mmHg