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Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 ± 12.7 years old; 54.8% hypertensive) started CR 26.2 ± 17.3 days after surgery. During 30.4 ±11.6 days, they underwent 14.5 ± 4.7 sessions of endurance cycling training, and 11.8 ± 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 ± 10.2 watts and 1.2 ± 0.6 METs, respectively. The maximal BP reached during endurance training was 143 ± 14/88 ± 14 mmHg. The heart rate (HR) reserve improved from 20.2 ± 13.9 bpm to 33.2 ± 16.8 bpm while the resting HR decreased from 86.1 ± 17.4 bpm to 76.4 ± 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training. [ABSTRACT FROM AUTHOR]

This article cites a multicentric prospective study, evaluating the safety and feasibility of an early exercise training program (ETP) after mitral valve (MV) repair. A total of 251 patients who were hospitalized in 13 postoperative centers in France after MV repair from September 1, 2002, to June 30, 2003, were selected for this study. Clinical, echocardiographic, and ergometric assessments were made before and after completion of the cardiac rehabilitation program. All patients underwent two cardiopulmonary exercise tests before and after the ETP. The ETP included calisthenics and endurance bicycle training 5 days a week for inpatients and 3 days a week for outpatients. Findings of the study suggest that ETP after MV repair does not deteriorate the outcome of recent surgery and seems efficient.

Exercise training (ET) increases exercise tolerance, improves quality of life and likely the prognosis in heart failure patients with reduced ejection fraction (HFrEF). However, some patients do not improve, whereas exercise training response is still poorly understood. Measurement of cardiac output during cardiopulmonary exercise test might allow ET response assessment according to the different steps of oxygen transport. Fifty-three patients with HFrEF (24 with ischemic cardiomyopathy (ICM) and 29 with dilated cardiomyopathy (DCM) had an aerobic ET. Before and after ET program, peak oxygen consumption (VO 2peak) and cardiac output using thoracic impedancemetry were measured. Oxygen convection (QO 2peak) and diffusion (DO 2) were calculated using Fick's principle and Fick's simplified law. Patients were considered as responders if the gain was superior to 10%. We found 55% VO 2peak responders, 62% QO 2peak responders and 56% DO 2 responders. Four patients did not have any response. None baseline predictive factor for VO 2peak response was found. QO 2peak response was related to exercise stroke volume (r = 0.84), cardiac power (r = 0.83) and systemic vascular resistance (SVR peak) (r = −0.42) responses. Cardiac power response was higher in patients with ICM than in those with DCM (p < 0.05). Predictors of QO2 peak response were low baseline exercise stroke volume and ICM etiology. Predictors of DO 2 response were higher baseline blood creatinine and prolonged training. The analysis of the response to training in patients with HFrEF according to the different steps of oxygen transport revealed different phenotypes on VO 2peak responses, namely responses in either oxygen convection and/or diffusion. [Display omitted] • Usefulness of routine noninvasive cardiac output measurement during CPET in refining the phenotypes of ET responses according to oxygen transport steps. • Analysis of the response to training in patients with HFrEF according to the different steps of oxygen transport revealed different phenotypes on VO 2peak responses, namely responses in either oxygen convection and/or diffusion • Predictors of response in oxygen delivery were low baseline exercise stroke volume and ischemic cardiomyopathy etiology. Predictors of response in peripheral oxygen diffusion were higher baseline blood creatinine and prolonged training. • It might be hypothesized that the number of exercise training responders could be increased by adapting training programs according to these predictive baseline characteristics. [ABSTRACT FROM AUTHOR]