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

Area of Science:

• Cardiology
• Thoracic Surgery
• Exercise Physiology

Background:

• Cardiorespiratory fitness, measured by peak oxygen consumption (VO2peak), is crucial for predicting cardiovascular disease and mortality.
• Limited data exist on VO2peak post-repair for acute type A aortic dissection (ATAAD) and proximal thoracic aortic aneurysm (pTAA).

Purpose of the Study:

• To prospectively evaluate VO2peak, functional capacity, and health-related quality of life (HR-QOL) after open repair of ATAAD and pTAA.
• To assess changes in these parameters at early (3 months) and late (15 months) post-operative time points.

Main Methods:

• Prospective evaluation of 21 ATAAD and 43 pTAA patients post-open repair.
• Cardiopulmonary exercise testing (CPX), 6-minute walk testing, and HR-QOL assessments were performed at 3 and 15 months.
• Analysis included changes in VO2peak, functional capacity, HR-QOL, and body mass index (BMI).

Main Results:

• BMI significantly increased in both groups, with over 50% classified as obese.
• VO2peak showed a modest increase in ATAAD patients (0.8 mLO2·kg-1·min-1) but a significant increase in pTAA patients (2.2 mLO2·kg-1·min-1).
• ATAAD patients experienced decreased anxiety, while pTAA patients showed improved functional capacity and HR-QOL. ATAAD VO2peak remained 36% below predicted values.

Conclusions:

• While VO2peak improves post-pTAA repair, ATAAD survivors exhibit persistently low cardiorespiratory fitness.
• Post-operative CPX is recommended to guide exercise prescription for ATAAD patients to mitigate morbidity and mortality risks.
• Monitoring exercise tolerance and blood pressure response is key for optimizing recovery and long-term outcomes.