TY  - JOUR
A1  - Boujemaa, Hajar
A1  - Yilmaz, Alaaddin
A1  - Robic, Boris
A1  - Koppo, Katrien
A1  - Claessen, Guido
A1  - Frederix, Ines
A1  - Dendale, Paul
A1  - Völler, Heinz
A1  - van Loon, Luc J. C.
A1  - Hansen, Dominique
T1  - The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function
JF  - Experimental physiology
N2  - 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. Twenty two patients with severe aortic stenosis (AS) (aortic valve area (AVA) < 1.0 cm(2)) were preoperatively compared to 22 healthy controls during submaximal constant-workload endurance-type exercise for oxygen uptake (V-O2), carbon dioxide output (V-CO2), respiratory gas exchange ratio, expiratory volume (V-E), ventilatory equivalents for O-2 (V-E/V-O2) and CO2 (V-E/V-CO2), respiratory rate (RR), tidal volume (V-t), heart rate (HR), oxygen pulse (V-O2/HR), blood lactate, Borg ratings of perceived exertion (RPE) and exercise-onset V-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 (V-E/V-O2 and V-E/V-CO2) were significantly elevated, V-O2 and V-O2/HR were significantly lowered, and exercise-onset V-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, V-E/V-O2 and V-E/V-CO2 further worsened significantly within 5 days after surgery, accompanied by elevations in Borg RPE, V-E and RR, and lowered V-t. At 21 days after mini-AVR, exercise-onset V-O2 kinetics further slowed significantly (P < 0.05). A decline in pulmonary function was observed early aftermini-AVRsurgery, which was followed by a decline in skeletal muscle function in the subsequent weeks of recovery. Therefore, a tailored rehabilitation programmeshould include training modalities for the respiratory and peripheral muscular system.
KW  - aortic valve stenosis
KW  - exercise tolerance
KW  - surgery
Y1  - 2019
U6  - https://doi.org/10.1113/EP087407
SN  - 0958-0670
SN  - 1469-445X
VL  - 104
IS  - 6
SP  - 855
EP  - 865
PB  - Wiley
CY  - Hoboken
ER  -