Effect of exercise on the heart in patients who underwent a surgical aortic valve replacement with either a mechanical prosthesis or a Ross procedure Circulatory System
Conditions
Interventions
For patient selection, 2 cohorts of patients who underwent aortic valve replacement with either a Ross procedure or a mechanical prosthesis were matched according to age, sexe, aortic valve disease, a
Sponsors
Montreal Heart Institute
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: All adults between 18 and 64 years old who underwent AVR with mechanical prosthesis or with Ross procedure at our institution between 2007 and 2016.
Exclusion criteria
Exclusion criteria: 1. Uncontrolled hypertension at rest (>150/90 mmHg) 2. LVEF 50 mmHg) 7. Atrial fibrillation 8. Cardiovascular complications (stroke, transient ischemic attack, myocardial infarction, pericardial effusion, heart failure, malignant arrhythmias) within the last 3 months 9. Patients with a permanent pacemaker 10. More than moderate mitral insufficiency 11. Contraindication to MRI 12. Impossibility to perform a stress test on an ergocycle (limiting physical capacities)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Left ventricular workload estimated by the valvulo-arterial impedance (Zva) measured at rest and during exercise. (The valvulo-arterial impedance equals the sum of the systolic blood pressure (sBP) and the mean aortic valve gradient divided by the stroke volume index: Zva= [sBP + mean AV gradient] / Stroke volume index. All the 3 parameters are measured at the same time during echocardiography and CMRI.) | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Energy Loss Index (ELI) calculated as [(AVAxAa)/(Aa-AVA)]/BSA at rest and during exercise 2. Aortic valve area (AVA) measured by transthoracic echocardiogram (TTE) and MRI at rest and during exercise 3. Ascending aorta crossectional area (Aa) measured by TTE and MRI at rest and during exercise 4. Left ventricular stroke work (LVSW) calculated as (MAP + mean AV gradient) x Stroke volume x 0.0136 at rest and during exercise 5. Aortic valve gradients measured by TTE and MRI at rest and during exercise 6. LV diameters and volumes measured by TTE and MRI at rest and during exercise 7. LV ejection fraction measured by TTE and MRI at rest and during exercise 8. MAP, systolic arterial pressure, diastolic arterial pressure, heart rate at rest and during exercise | — |
Countries
Canada
Outcome results
None listed