Cardiorespiratory Fitness After Open Repair for Acute Type A Aortic Dissection – A Prospective Study.

Norton EL; Rubenfire M; Fink S; Sitzmann J; Hobbs RD; Saberi S; Willer CJ; Yang B; Hornsby WE;

Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2021 Jun 05. Date of Electronic Publication: 2021 Jun 05.

Objective: Cardiorespiratory fitness (as measured by peak oxygen consumption [VO 2peak ]) is an independent predictor of cardiovascular disease and all-cause mortality. Limited data exist on VO 2peak following repair for an acute type A aortic dissection (ATAAD) or proximal thoracic aortic aneurysm (pTAA). This study prospectively evaluated VO 2peak , functional capacity, and health-related quality of life (HR-QOL) following open repair.
Methods: Participants with a history of an ATAAD (n=21) or pTAA (n=43) performed cardiopulmonary exercise testing (CPX), six-minute walk testing, and HR-QOL at 3 (early) and 15 (late) months following open repair.
Results:   The median age at time of surgery was 55-years-old and 60-years-old in the ATAAD and pTAA groups, respectively. Body mass index significantly increased between early and late timepoints for both ATAAD (p=0.0245, 56% obese) and pTAA groups (p=0.0045, 54% obese). VO 2peak modestly increased by 0.8 mLO2•kg-1•min-1 within the ATAAD group (P=0.2312) while VO 2peak significantly increased by 2.2 mLO2•kg-1•min-1 within the pTAA group (P=0.0003). Anxiety significantly decreased in the ATAAD group whereas functional capacity and HR-QOL metrics (social roles and activities, physical function) significantly improved in the pTAA group (p values<0.05). There were no serious adverse events during CPX.
Conclusion: Cardiorespiratory fitness among the ATAAD group remained 36% below predicted normative values >1 year after repair. CPX should be considered post-operatively to evaluate exercise tolerance and blood pressure response to determine whether mild-to-moderate aerobic exercise should be recommended to reduce future risk of morbidity and mortality.