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The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function
Author(s) -
Boujemaa Hajar,
Yilmaz Alaaddin,
Robic Boris,
Koppo Katrien,
Claessen Guido,
Frederix Ines,
Dendale Paul,
Völler Heinz,
Loon Luc JC,
Hansen Dominique
Publication year - 2019
Publication title -
experimental physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.925
H-Index - 101
eISSN - 1469-445X
pISSN - 0958-0670
DOI - 10.1113/ep087407
Subject(s) - medicine , cardiology , aortic valve replacement , respiratory exchange ratio , skeletal muscle , respiratory minute volume , pulmonary function testing , aortic valve , heart rate , respiratory system , stenosis , blood pressure
New FindingsWhat is the central question of this study? How does surgical aortic valve replacement affect cardiopulmonary and muscle function during exercise?What is the main finding and its importance? Early after the surgical replacement of the aortic valve a significant decline in pulmonary function was observed, which was followed by a decline in skeletal muscle function in the subsequent weeks of recovery. These date reiterate, despite restoration of aortic valve function, the need for a tailored rehabilitation programme for the respiratory and peripheral muscular system.Abstract Suboptimal post‐operative improvements in functional capacity are often observed after minimally invasive aortic valve replacement (mini‐AVR). It remains to be studied how AVR affects the cardiopulmonary and skeletal muscle function during exercise to explain these clinical observations and to provide a basis for improved/tailored post‐operative rehabilitation. Twenty‐two patients with severe aortic stenosis (AS) (aortic valve area (AVA) <1.0 cm²) were pre‐operatively compared to 22 healthy controls during submaximal constant‐workload endurance‐type exercise for oxygen uptake ( V ̇ O 2 ), carbon dioxide output ( V ̇ C O 2), respiratory gas exchange ratio, expiratory volume ( V ̇ E ), ventilatory equivalents for O 2 ( V ̇ E / V ̇ O 2 ) and CO 2 ( V ̇ E / V ̇ C O 2), respiratory rate (RR), tidal volume ( V t ), heart rate (HR), oxygen pulse ( V ̇ O 2 /HR), blood lactate, Borg ratings of perceived exertion (RPE) and exercise‐onsetV ̇ O 2kinetics. These exercise tests were repeated at 5 and 21 days after AVR surgery ( n = 14), along with echocardiographic examinations. Respiratory exchange ratio and ventilatory equivalents ( V ̇ E / V ̇ O 2andV ̇ E / V ̇ C O 2) were significantly elevated,V ̇ O 2andV ̇ O 2 /HR were significantly lowered, and exercise‐onsetV ̇ O 2kinetics were significantly slower in AS patients vs . healthy controls ( P < 0.05). Although the AVA was restored by mini‐AVR in AS patients,V ̇ E / V ̇ O 2andV ̇ E / V ̇ C O 2further worsened significantly within 5 days after surgery, accompanied by elevations in Borg RPE,V ̇ E and RR, and lowered V t . At 21 days after mini‐AVR, exercise‐onsetV ̇ O 2kinetics further slowed significantly ( P < 0.05). A decline in pulmonary function was observed early after mini‐AVR surgery, which was followed by a decline in skeletal muscle function in the subsequent weeks of recovery. Therefore, a tailored rehabilitation programme should include training modalities for the respiratory and peripheral muscular system.