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CLINICAL STUDY

Postoperative exercise tolerance after aortic valve replacement by small-size prosthesis

Functional consequence of small-size aortic prosthesis

Pierre Becassis, MD^*, Maurice Hayot, MD, PhD, Jean-Marc Frapier, MD, Florence Leclercq, MD^*, Lionel Beck, MD^*, J.érome Brunet, MD^*, Eric Arnaud, MD^*, Christian Prefaut, MD, PhD, Paul-André Chaptal, MD, J. M. Davy, MD^*, Patrick Messner-Pellenc, MD, PhD^* and R. Grolleau, MD^*

^* Services de Cardiologie, Hopital Arnaud de Villeneuve, Montpellier, France
Service d’Exploration Fonctionnelle, Hopital Arnaud de Villeneuve, Montpellier, France
Service de Chirurgie Cardiaque et Vasculaire, Hopital Arnaud de Villeneuve, Montpellier, France

Manuscript received August 25, 1998; revised manuscript received March 1, 2000, accepted April 12, 2000.

Reprint requests and correspondence: Dr. Pierre Becassis, Service de Cardiologie B, Hopital A. de Villeneuve, 371 Avenue Doyen Gaston Giraud, 34000 Montpellier, France

OBJECTIVES

The objective of this study was to determine whether a small-size valve prosthesis contributes to exercise intolerance, as assessed by VO₂ 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 (VO₂ 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: VO₂ 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 VO₂max.

CONCLUSIONS

Valve replacement by small aortic prosthesis does not seem to be a factor of exercise intolerance as assessed by VO₂ max in patients without LVEF dysfunction before surgery.

Abbreviations and Acronyms   FEV1 = forced expiratory volume in 1 s   HR = heart rate   LVEF = left ventricular ejection fraction   MH = Medtronic Hall   R = respiratory gas exchange ratio (VCO2/VO2)   SJM = St Jude Medical   VC = vital capacity   VEmax = minute ventilation at peak exercise   VO2max = maximal oxygen uptake   VO2 peak = peak oxygen consumption   VR = ventilatory reserve   Vt = ventilatory threshold   Wmax = maximal workload

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