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Longitudinal Changes in Exercise Capacity in Patients Who Underwent Ross Procedure and Mechanical Aortic Valve Replacement: Does the Type of Surgery Matter?

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Abstract

The surgical options for significant aortic valve disease include either Ross procedure (RP) or aortic valve replacement (AVR). The exercise stress test is routinely performed in these patients to assess the objective functional capacity. This retrospective study was conducted to evaluate the differences and the longitudinal changes of exercise capacity in patients following the RP and AVR for aortic valve disease. This is an IRB approved retrospective study and included patients who had either RP or AVR performed for aortic valve disease and had at least one exercise stress test performed after the surgical procedure. Patients with other congenital heart disease, pacemaker or defibrillators, and those with inadequate data were excluded. Demographic data including age at surgery, type of surgery and type of aortic valve was collected. Data regarding treadmill cardiopulmonary exercise test (CPET) was also collected. A total of 47 patients met inclusion criteria and were equally represented in each group, i.e. RP [n = 23, 73.9% male, age at surgery 11.2 (4.5–15.9) years] vs. AVR [n = 24, 88% mechanical AVR, 60.9% male, age at surgery 15.1 (12.8–19.4) years]. There was a significant decline in predicted oxygen consumption (%VO2) at time of first post-operative CPET in patients after AVR compared to RP (79 vs. 88%, p = 0.048) over a similar accrued median interval follow-up (4.6 vs. 6.2 years, p = 0.2). The longitudinal follow-up analysis of following AVR (n = 11, 54.5% male, median inter-test duration of 5 years) showed significant decline in peak exercise capacity or VO2 (34.2 vs. 26.2 vs., p = 0.006). In contrast, after RP (n = 12 patients [58.3% male, median inter-test duration 7.1 of years], exercise capacity and other key parameters remained preserved. In this small sentinel study, we report a better initial exercise capacity among patients after RP compared to AVR over an intermediate follow-up. During longitudinal follow-up in a subset of patients, exercise capacity remained preserved amongst the RP group while it further declined in the AVR group.

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Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA

    Daiji Takajo & Vasudha Kota

  2. Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA

    Preetha P. L. Balakrishnan, Marjorie Gayanilo, Chenni Sriram & Sanjeev Aggarwal

Authors
  1. Daiji Takajo
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  2. Vasudha Kota
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  3. Preetha P. L. Balakrishnan
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  4. Marjorie Gayanilo
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  5. Chenni Sriram
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  6. Sanjeev Aggarwal
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Contributions

Dr. Takajo and Dr. Aggarwal conceptualized and designed the study, designed the data collected instruments, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Kota designed the data collection instruments, collected data, and critically reviewed the manuscript. Drs. Balakrishnan, Gayanilo, and Sriram critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Daiji Takajo.

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The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Wayne State University approved this study.

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Takajo, D., Kota, V., Balakrishnan, P.P.L. et al. Longitudinal Changes in Exercise Capacity in Patients Who Underwent Ross Procedure and Mechanical Aortic Valve Replacement: Does the Type of Surgery Matter?. Pediatr Cardiol 42, 1018–1025 (2021). https://doi.org/10.1007/s00246-021-02575-4

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  • DOI: https://doi.org/10.1007/s00246-021-02575-4

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