Cardiopulmonary Exercise Testing Following Open Repair for a Proximal Thoracic Aortic Aneurysm or Dissection

Area of Science:

• Cardiology
• Thoracic Surgery
• Exercise Physiology

Background:

• Limited data exists on cardiopulmonary exercise testing (CPX) and cardiorespiratory fitness (CRF) post-proximal thoracic aortic aneurysm or dissection repair.
• Assessing these parameters is crucial for understanding patient recovery and long-term outcomes.

Purpose of the Study:

• To evaluate serious adverse events during CPX after open repair of proximal thoracic aortic aneurysms or dissections.
• To determine the abnormal exercise test event rate.
• To assess CRF, specifically peak oxygen uptake (O2peak), and blood pressure response post-repair.

Main Methods:

• Retrospective and prospective enrollment of 128 patients undergoing thoracic aortic repair.
• Patients were categorized into three groups: bicuspid aortic valve/thoracic aortic aneurysm, tricuspid aortic valve/thoracic aortic aneurysm, and acute type A aortic dissection.
• Cardiopulmonary exercise testing (CPX) was performed a median of 2.9 months post-repair.

Main Results:

• No serious adverse events were reported during CPX; the abnormal exercise test rate was 2%.
• Peak oxygen uptake (O2peak) was significantly reduced (<36% predicted) across all patient groups compared to normative values.
• The acute type A aortic dissection group exhibited the most pronounced impairment in O2peak (<40% predicted), significantly lower than other groups.

Conclusions:

• CPX is safe following thoracic aortic repair, with a low event rate.
• Reduced cardiorespiratory fitness (CRF), indicated by low O2peak, is prevalent post-repair, especially in acute type A aortic dissection patients.
• The significant reduction in CRF highlights its potential clinical importance and prognostic value.