Hornsby WE; Departments of Internal Medicine, Division of Cardiovascular Medicine (Drs Hornsby, Saberi, Brook, Willer, Eagle, and Rubenfire and Ms Fink) and Cardiac Surgery (Drs Wu, Patel, and Yang), University of Michigan, Michigan Medicine, Ann Arbor; Creighton University School of Medicine, Omaha, Nebraska (Ms Norton); Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada (Dr McGowan); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York (Dr Jones); Departments of Computational Medicine and Bioinformatics and Human Genetics, University of Michigan, Ann Arbor (Dr Willer); and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana (Dr Lavie).
Journal Of Cardiopulmonary Rehabilitation And Prevention [J Cardiopulm Rehabil Prev] 2019 Aug 29. Date of Electronic Publication: 2019 Aug 29.
Purpose: There are limited data on cardiopulmonary exercise testing (CPX) and cardiorespiratory fitness (CRF), following open repair for a proximal thoracic aortic aneurysm or dissection. The aim was to evaluate serious adverse events, abnormal CPX event rate, CRF (peak oxygen uptake, Vo2peak), and blood pressure.
Methods: Patients were retrospectively identified from cardiac rehabilitation participation or prospectively enrolled in a research study and grouped by phenotype: (1) bicuspid aortic valve/thoracic aortic aneurysm, (2) tricuspid aortic valve/thoracic aortic aneurysm, and (3) acute type A aortic dissection.
Results: Patients (n = 128) completed a CPX a median of 2.9 mo (interquartile range: 1.8, 3.5) following repair. No serious adverse events were reported, although 3 abnormal exercise tests (2% event rate) were observed. Eighty-one percent of CPX studies were considered peak effort (defined as respiratory exchange ratio of ≥1.05). Median measured Vo2peak was <36% predicted normative values (19.2 mL·kgmin vs 29.3 mL·kg·min, P < .0001); the most marked impairment in Vo2peak was observed in the acute type A aortic dissection group (<40% normative values), which was significantly different from other groups (P < .05). Peak exercise systolic and diastolic blood pressures were 160 mm Hg (144, 172) and 70 mm Hg (62, 80), with no differences noted between groups.
Conclusions: We observed no serious adverse events with an abnormal CPX event rate of only 2% 3 mo following repair for a proximal thoracic aortic aneurysm or dissection. Vo2peak was reduced among all patient groups, especially the acute type A aortic dissection group, which may be clinically significant, given the well-established prognostic importance of reduced cardiorespiratory fitness.