Postoperative exercise tolerance after aortic valve replacement by small-size prosthesis : Functional consequence of small-size aortic prosthesis

详细信息    查看全文

• 作者：Pierre Becassis ; Maurice Hayot ; Jean-Marc Frapier ; Florence Leclercq ; Lionel Beck ; Jé ; rome Brunet ; Eric Arnaud ; Christian Prefaut ; Paul-André ; . Chaptal ; J. M. Davy ; Patrick Messner-Pellenc ; R
• 关键词：ACC/AHA Clinical Competence Statement ; electrophysiology ; ablation ; cardioversion ; arrhythmia
• 刊名：Journal of the American College of Cardiology
• 出版年：2000
• 出版时间：September 2000
• 年：2000
• 卷：36
• 期：3
• 页码：871-877
• 全文大小：439 K

文摘

OBJECTIVES

The objective of this study was to determine whether a small-size valve prosthesis contributes to exercise intolerance, as assessed by Vmg src=""http://www.sciencedirect.com/cache/MiamiImageURL/B6T18-412RF9G-15-D/0?wchp=dGLbVzz-zSkWW"" alt=""Image"" align=""absbottom"" border=""0"" height=11 width=12>₂ measurement during an exhaustive cycle ergometer exercise.

BACKGROUND

The determinants of exercise capacity after mechanical aortic replacement are not well known. The selection of small valve sizes has, however, been described as an independent predictor of exercise intolerance as assessed by exercise duration. Maximal oxygen uptake (Vmg src=""http://www.sciencedirect.com/cache/MiamiImageURL/B6T18-412RF9G-15-D/0?wchp=dGLbVzz-zSkWW"" alt=""Image"" align=""absbottom"" border=""0"" height=11 width=12>₂ max) is a good index of exercise tolerance.

METHODS

Fourteen patients were eligible, with a mean age of 62 ± 6 years. Before surgery, the mean left ventricular ejection fraction (LVEF) was 73 ± 8 % . Two valve types with small diameter (19 to 21 mm) were used: Medtronic Hall and St Jude Medical. A healthy sedentary control group (n = 14) paired for age, weight and size was constituted. After one year of follow-up, cardiorespiratory tests were performed. In addition, the gradients through the prostheses were determined by continuous pulse Doppler at rest and immediately after the cardiorespiratory test.

RESULTS

The exercise tolerance was not significantly different between the control group and patient group: Vmg src=""http://www.sciencedirect.com/cache/MiamiImageURL/B6T18-412RF9G-15-D/0?wchp=dGLbVzz-zSkWW"" alt=""Image"" align=""absbottom"" border=""0"" height=11 width=12>₂ peak (21.7 vs. 20.4 ml/kg/min; p = 0.42), workloads (115 vs. 93 W; p = 0.13) and ventilatory parameters were similar. The mean and peak gradients at rest and during exercise were not correlated with Vmg src=""http://www.sciencedirect.com/cache/MiamiImageURL/B6T18-412RF9G-15-D/0?wchp=dGLbVzz-zSkWW"" alt=""Image"" align=""absbottom"" border=""0"" height=11 width=12>₂max.

CONCLUSIONS

Valve replacement by small aortic prosthesis does not seem to be a factor of exercise intolerance as assessed by Vmg src=""http://www.sciencedirect.com/cache/MiamiImageURL/B6T18-412RF9G-15-D/0?wchp=dGLbVzz-zSkWW"" alt=""Image"" align=""absbottom"" border=""0"" height=11 width=12>₂ max in patients without LVEF dysfunction before surgery.