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

  • Elizabeth L. Norton
    Affiliations
    Creighton University School of Medicine, Omaha, Nebraska
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  • Kuan-Han H. Wu
    Affiliations
    Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
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  • Melvyn Rubenfire
    Affiliations
    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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  • Samantha Fink
    Affiliations
    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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  • Jacob Sitzmann
    Affiliations
    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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  • Reilly D. Hobbs
    Affiliations
    Department of Cardiac Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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  • Sara Saberi
    Affiliations
    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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  • Cristen J. Willer
    Affiliations
    Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan

    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan

    Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
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  • Author Footnotes
    1 These authors jointly supervised this work and share co-senior authorship/correspondence.
    Bo Yang
    Correspondence
    Address reprint requests to Bo Yang, MD, PhD, Department of Cardiac Surgery, University of Michigan, Michigan Medicine, 1500 East Medical Center Drive, 5155 Frankel Cardiovascular Center, Ann Arbor, MI, 48109.
    Footnotes
    1 These authors jointly supervised this work and share co-senior authorship/correspondence.
    Affiliations
    Department of Cardiac Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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  • Author Footnotes
    1 These authors jointly supervised this work and share co-senior authorship/correspondence.
    Whitney E. Hornsby
    Correspondence
    Address reprint requests to Whitney E. Hornsby, PhD, Department of Internal Medicine, University of Michigan, Michigan Medicine, 1500 East Medical Center Drive, 5804 Medical Science II, 1241 E. Catherine St., Ann Arbor, MI, 48109-5618.
    Footnotes
    1 These authors jointly supervised this work and share co-senior authorship/correspondence.
    Affiliations
    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
    Search for articles by this author
  • Author Footnotes
    1 These authors jointly supervised this work and share co-senior authorship/correspondence.
      Cardiorespiratory fitness (as measured by peak oxygen consumption [VO2peak]) is an independent predictor of cardiovascular disease and all-cause mortality. Limited data exist on VO2peak following repair for an acute type A aortic dissection (ATAAD) or proximal thoracic aortic aneurysm (pTAA). This study prospectively evaluated VO2peak, functional capacity, and health-related quality of life (HR-QOL) following open repair. Participants with a history of an ATAAD (n = 21) or pTAA (n = 43) performed cardiopulmonary exercise testing (CPX), 6-minute walk testing, and HR-QOL at 3 (early) and 15 (late) months following open repair. The median age at time of surgery was 55-years-old and 60-years-old in the ATAAD and pTAA groups, respectively. Body mass index significantly increased between early and late timepoints for both ATAAD (p = 0.0245, 56% obese) and pTAA groups (p = 0.0045, 54% obese). VO2peak modestly increased by 0.8 mLO2·kg−1·min−1 within the ATAAD group (p = 0.2312) while VO2peak significantly increased by 2.2 mLO2·kg−1·min−1 within the pTAA group (p = 0.0003). Anxiety significantly decreased in the ATAAD group whereas functional capacity and HR-QOL metrics (social roles and activities, physical function) significantly improved in the pTAA group (p values < 0.05). There were no serious adverse events during CPX. Cardiorespiratory fitness among the ATAAD group remained 36% below predicted normative values >1 year after repair. CPX should be considered post-operatively to evaluate exercise tolerance and blood pressure response to determine whether mild-to-moderate aerobic exercise should be recommended to reduce future risk of morbidity and mortality.

      Graphical Abstract

      Keywords

      Abbreviations:

      ATAAD (acute type A aortic dissection), CPX (cardiopulmonary exercise testing), FRIEND Registry (Fitness Registry and the Importance of Exercise National Database), HR (heart rate), LVEF (left ventricular ejection fraction), PROs (patient reported outcomes), pTAA (proximal thoracic aortic aneurysm), VO2peak (peak oxygen consumption), (RER (respiratory exchange ratio), 6MWD (6 minute walk distance)
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      Linked Article

      • Commentary: Peak VO2 After Acute Aortic Dissection: Is it Worth the Effort?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Cardiorespiratory fitness, despite being a powerful measure of overall health, is poorly understood in the population of patients who have undergone proximal aortic surgery. In this issue, Norton and colleagues have taken the important step of making direct assessments of cardiorespiratory fitness, using state-of-the-art measures of peak oxygen consumption (VO2) at 2 time points: 3 and 15 months postoperatively.1
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      • Commentary: A Puzzle With Many “Moving” Parts
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Outpatient cardiac rehabilitation (CR) receives a class I (level of evidence A) recommendation1,2 for patients after coronary artery bypass grafting due to its proven mortality benefit and prevention of future adverse cardiac events.3 In contrast, the evidence for CR after thoracic aortic surgery is scant. Both American and European guidelines are largely silent on the role for exercise rehabilitation in those with aneurysmal aortic disease due to lack of good quality data.4,5 The 2014 Canadian Cardiovascular Society position statement provides a strong recommendation against strenuous resistance and isometric exercise in patients with thoracic aortic disease, acknowledging that available evidence is very low quality.
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