title: Impact of the preoperative risk and the type of surgery on exercise capacity and training after valvular surgery.
abstract: Information on exercise capacity and training in patients who underwent valvular surgery is scarce. The aim of this study is to evaluate postoperative exercise capacity and functional improvement after exercise training according to the preoperative risk and type of surgery. In this prospective study, 145 patients who underwent aortic valve surgery (AVS) or mitral valve surgery (MVS) and who were referred for cardiac rehabilitation were stratified according to the preoperative risk (European System for Cardiac Operative Risk Evaluation [EuroSCORE]) and type of surgery (sternotomy vs ministernotomy or port access). Exercise capacity was evaluated at the start and end of cardiac rehabilitation. Postoperative exercise capacity and the benefit from exercise training were compared between the groups. Patients with a higher preoperative risk had a worse postoperative exercise capacity, with a lower load, peak VO2, anaerobic threshold and 6-minute walking distance (all p<0.001), and a higher VE/VCO2 slope (p=0.01). In MVS, port access patients performed significantly better at baseline (all p<0.05), but in AVS, ministernotomy patients performed better than sternotomy patients with a concomitant coronary artery bypass graft (p<0.05). Training resulted in an improvement in exercise capacity in each risk group and each type of surgery (all p<0.05). This gain in exercise capacity was comparable for the EuroSCORE risk groups and for the types of surgery, for patients after AVS or MVS. In conclusion, exercise capacity after cardiac surgery is related to the preoperative risk and the type of surgery. Despite these differences in postoperative exercise capacity, a similar benefit from exercise training is obtained, regardless of their preoperative risk or type of surgery.
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium. Electronic address: Sofie.pardaens@ugent.be.
authors.forename: Sofie
authors.initials: S
authors.lastname: Pardaens
authors.affiliation: Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
authors.forename: Veronique
authors.initials: V
authors.lastname: Moerman
authors.affiliation: Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Willems
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Calders
authors.affiliation: Cardiovascular Center, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.affiliation: Cardiovascular Center, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Vanderheyden
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: De Sutter
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome