Early exercise training feasibility after aortic valve repair: A multicentre prospective French survey on behalf of the Aortic Valve repair International Registry (AVIATOR)

Background. - Standardization of aortic valve repair by the external ring annuloplasty approach is an alternative to valve replacement to avoid prosthetic valve-related events. Although the benefit of exercise training to improve postoperative exercise tolerance has been demonstrated in many conditions after cardiac surgery, it has never been described after aortic valve repair. Objectives. - To evaluate the feasibility of an early exercise training programme after aortic valve repair. Methods. - Consecutive patients were prospectively included in 13 postoperative centres. Patients underwent an exercise training programme for approximately 3-5 weeks. Transthoracic echocardiography and a cardiopulmonary exercise test were performed before and after the exercise training programme. Results. - Fifty patients (mean +/- standard deviation [SD] age: 50 +/- 13 years) were included a mean of 13.6 +/- 12.0 days after aortic valve repair. The preoperative degree of aortic insufficiency was moderate to severe in 35 patients (70%) and the aortic valve was bicuspid in 24 patients (48%). Valve-sparing root replacement and isolated aortic valve repair (including 10% supracoronary aorta replacement) were performed in 64% and 36% of patients, respectively. We found no aortic insufficiency occurrence or worsening and no adverse clinical events after the exercise training programme. Mean left ventricular ejection fraction increased significantly (from 54% +/- 8% to 57% +/- 9%; P=0.0007). Mean peak oxygen consumption and first ventilatory threshold increased from 17.0 +/- 5.3 to 22.5 +/- 7.8 mL/kg/min (32% increase) and from 12.0 +/- 3.9 to 14.3 +/- 5.2 mL/kg/min (19% increase), respectively (both P< 0.05). Conclusion. - Exercise training early after aortic valve repair is safe and seems to significantly improve exercise capacity. (C) 2020 Elsevier Masson SAS. All rights reserved.