title: Aerobic training in adults after atrial switch procedure for transposition of the great arteries improves exercise capacity without impairing systemic right ventricular function.
abstract: BACKGROUND
  Exercise training safely and efficiently improves symptoms in patients with heart failure due to left ventricular dysfunction. However, studies in congenital heart disease with systemic right ventricle are scarce and results are controversial. In a randomised controlled study we investigated the effect of aerobic exercise training on exercise capacity and systemic right ventricular function in adults with d-transposition of the great arteries after atrial redirection surgery (28.2 ± 3.0 years after Mustard procedure).
  
  
  METHODS
  48 patients (31 male, age 29.3 ± 3.4 years) were randomly allocated to 24 weeks of structured exercise training or usual care. Primary endpoint was the change in maximum oxygen uptake (peak VO2). Secondary endpoints were systemic right ventricular diameters determined by cardiac magnetic resonance imaging (CMR). Data were analysed per intention to treat analysis.
  
  
  RESULTS
  At baseline peak VO2 was 25.5 ± 4.7 ml/kg/min in control and 24.0 ± 5 ml/kg/min in the training group (p=0.3). Training significantly improved exercise capacity (treatment effect for peak VO2 3.8 ml/kg/min, 95% CI: 1.8 to 5.7; p=0.001), work load (p=0.002), maximum exercise time (p=0.002), and NYHA class (p=0.046). Systemic ventricular function and volumes determined by CMR remained unchanged. None of the patients developed signs of cardiac decompensation or arrhythmias while on exercise training.
  
  
  CONCLUSIONS
  Aerobic exercise training did not detrimentally affect systemic right ventricular function, but significantly improved exercise capacity and heart failure symptoms. Aerobic exercise training can be recommended for patients following atrial redirection surgery to improve exercise capacity and to lessen or prevent heart failure symptoms. (
  
  
  BACKGROUND
  ClinicalTrials.gov #NCT00837603).
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Germany. Electronic address: Westhoff-Bleck.Mechthild@MH-Hannover.de.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Westhoff-Bleck
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schieffer
authors.forename: Uwe
authors.initials: U
authors.lastname: Tegtbur
authors.forename: Gerd Peter
authors.initials: GP
authors.lastname: Meyer
authors.forename: Ludwig
authors.initials: L
authors.lastname: Hoy
authors.forename: Arnd
authors.initials: A
authors.lastname: Schaefer
authors.forename: Ezequiel Marcello
authors.initials: EM
authors.lastname: Tallone
authors.forename: Oktay
authors.initials: O
authors.lastname: Tutarel
authors.forename: Ramona
authors.initials: R
authors.lastname: Mertins
authors.forename: Lena Mara
authors.initials: LM
authors.lastname: Wilmink
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.forename: Philipp
authors.initials: P
authors.lastname: Roentgen
mesh_terms: D000328:Adult; D015444:Exercise / Q000502:physiology*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D014188:Transposition of Great Vessels / Q000503:physiopathology* / Q000601:surgery* / Q000628:therapy; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Cardiac magnetic resonance imaging; Congenital heart disease; Exercise training-subaortic right ventricle