The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function
Boujemaa, Hajar, Yilmaz, Alaaddin, Robic, Boris, Koppo, Katrien, Claessen, Guido, Frederix, Ines, Dendale, Paul, Völler, Heinz, van Loon, Luc J. C. and Hansen, Dominique. (2019) The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function. Experimental Physiology. 104(6), pp. 855 - 865. https://doi.org/10.1113/EP087407
|Authors||Boujemaa, Hajar, Yilmaz, Alaaddin, Robic, Boris, Koppo, Katrien, Claessen, Guido, Frederix, Ines, Dendale, Paul, Völler, Heinz, van Loon, Luc J. C. and Hansen, Dominique|
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. Twentytwo patients with severe aortic stenosis (AS) (aortic valve area (AVA) <1.0 cm2) were preoperatively compared to 22 healthy controls during submaximal constant-workload endurancetype exercise for oxygen uptake (V̇ O2 ), carbon dioxide output (V̇ CO2 ), respiratory gas exchange ratio, expiratory volume (V̇ E), ventilatory equivalents for O2 (V̇ E/V̇ O2 ) and CO2 (V̇ E/V̇ CO2 ), respiratory rate (RR), tidal volume (Vt), heart rate (HR), oxygen pulse (V̇ O2 /HR), blood lactate, Borg ratings of perceived exertion (RPE) and exercise-onset V̇ O2 kinetics. 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 (V̇ E/V̇ O2 and V̇ E/V̇ CO2 ) were significantly elevated, V̇ O2 and V̇ O2 /HR were significantly lowered, and exercise-onset V̇ O2 kinetics were significantly slower in AS patients vs. healthy controls (P < 0.05). Although the AVA was restored by mini-AVR in AS patients, V̇ E/V̇ O2 and V̇E/V̇ CO2 further worsened significantly within 5 days after surgery, accompanied by elevations in Borg RPE, V̇ E and RR, and lowered Vt. At 21 days after mini-AVR, exercise-onset V̇ O2 kinetics 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.
|Keywords||aortic valve stenosis; exercise tolerance; surgery|
|Journal citation||104 (6), pp. 855 - 865|
|Publisher||Wiley-Blackwell Publishing Ltd.|
|Digital Object Identifier (DOI)||https://doi.org/10.1113/EP087407|
|Open access||Open access|
|Page range||855 - 865|
|Research Group||Mary MacKillop Institute for Health Research|
|Author's accepted manuscript|
This is the peer reviewed version of the following article: Boujemaa, H, Yilmaz, A, Robic, B, et al. The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function. Experimental Physiology. 2019; 104: 855– 865. https://doi.org/10.1113/EP087407 , which has been published in final form at https://doi.org/10.1113/EP087407 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
|Place of publication||United Kingdom|
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