Evaluation of Exercise Capacity after Aortic Valve Surgery for Aortic Regurgitation in Nonelderly Patients: Repair versus Replacement

Background: Postoperative physical recovery is a crucial outcome determinant in young patients undergoing aortic valve (AV) surgery. However, such functional parameters have not been well evaluated in patients with predominant aortic regurgitation, particularly with respect to different AV procedures. Thus, we aimed to compare exercise capacity after AV repair vs. replacement (AVR) in nonelderly adults during the first postoperative year.

Method: Patients with isolated severe aortic regurgitation scheduled for AV surgery at our institution were prospectively included in our study from November 2018 to August 2020. Exercise capacity was evaluated upon admission, at 3 months and at 1 year postoperatively using the 6-minute walk test (6MWT) and cardiopulmonary exercise testing.

Results: A total of 45 patients (mean age: 44 ± 14 years, 93% male) were prospectively included: 28 patients underwent AV repair and 17 patients underwent AVR. Comparison of baseline to 1-year follow-up exercise capacity parameters showed a significantly increased 6MWT distance (mean increase: AV repair: +61 m, p < 0.001; AVR: +31 m, p = 0.022) and maximal work rate (WR) (mean increase: AV repair: +38 W, p < 0.001; AVR: +20 W, p = 0.019) in both groups. Significant improvements in maximal oxygen uptake (VO₂max) were only seen after AV repair (mean increase: VO₂max: +0.3 L/min, p < 0.001; VO₂max/kg: +3.14 (mL/min)/kg, p = 0.001). Although AV repair patients already showed a significantly higher preoperative WR (186 ± 64 vs. 135 ± 66 W, p = 0.014) and VO₂max (2.17 ± 0.63 vs. 1.59 ± 0.74 L/min, p = 0.008) compared with the AVR cohort, these differences were even more pronounced at 1-year follow-up (WR: 214 ± 53 vs. 144 ± 68 W, p = 0.002; VO₂max: 2.36 ± 0.56 vs. 1.71 ± 0.60 L/min, p = 0.003), indicating better functional improvement after AV repair. 6MWT distance at 1-year follow-up was also significantly greater after AV repair (648 ± 75 vs. 555 ± 118 m, p = 0.025).

Conclusion: Physical recovery in terms of significantly improved exercise capacity parameters was seen in AV repair as well as AVR patients during the first year after surgery for aortic regurgitation. However, significant improvements in VO2max and VO2max/kg were only found in the AV repair group. Most functional parameters were also significantly better at 1-year follow-up after AV repair versus AVR.

Publication History

Article published online:
03 February 2022