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Exercise tests before and after heart valve replacement

D G Gilmour, S G Spiro, M J Raphael

    British Journal of Diseases of the Chest
    |July 1, 1976
    PubMed
    Summary
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    Post-heart valve replacement surgery, exercise tolerance often remains impaired despite subjective symptom improvement. Objective exercise testing is crucial for assessing recovery after mitral and aortic valve replacement.

    Area of Science:

    • Cardiovascular Surgery
    • Exercise Physiology
    • Cardiac Rehabilitation

    Background:

    • Heart valve replacement surgery (mitral and aortic) aims to restore cardiac function.
    • Clinical assessment and patient-reported symptoms may not fully reflect post-operative exercise capacity.
    • Objective measures are needed to evaluate functional recovery after valve replacement.

    Purpose of the Study:

    • To assess exercise tolerance before and after mitral valve replacement (MVR) and aortic valve replacement (AVR).
    • To compare objective exercise capacity with subjective symptom reporting (New York Heart Association grading).
    • To evaluate the utility of simple ventilatory function tests in post-operative assessment.

    Main Methods:

    • A simple progressive exercise test was conducted pre- and post-operatively on 10 patients (5 MVR, 5 AVR).

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  • Heart rate and ventilation responses were measured relative to work rate (kilopond metres/min).
  • Clinical assessment (NYHA grading) and radiological evaluation were performed concurrently.

    • Main Results:

    • Clinical grading was a poor indicator of actual exercise tolerance post-surgery.
    • Only 2 of 10 patients achieved normal exercise tolerance, despite 6 reporting no exertional dyspnea.
    • Changes in simple ventilatory function tests were generally minimal.

    Conclusions:

    • Subjective improvement in symptoms does not always correlate with objective gains in working capacity after valve replacement.
    • Objective exercise tolerance measurements are essential for comprehensive post-operative evaluation following heart valve surgery.
    • Standard exercise testing should be integrated into the routine follow-up care for patients undergoing MVR and AVR.