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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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2
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Zhang LW, Peng YC, Pan Q, Li SL, Chen LW, Lin YJ. Compilation of a self-management assessment scale for postoperative patients with aortic dissection. Open Med (Wars) 2024; 19:20240939. [PMID: 38623458 PMCID: PMC11017179 DOI: 10.1515/med-2024-0939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024] Open
Abstract
Objective The aim of this research was to compile a self-management assessment scale for patients with aortic dissection (AD). The questionnaire is useful in making the patient aware of the need for post-operative care in order to contribute to improving the outcome and quality of life. Methods The initial version of the "postoperative self-management assessment scale for patients with aortic dissection" was developed using the Delphi expert consultation method based on qualitative research results, consultation of self-management-related literature, reference to the existing self-management scale, and self-efficacy theory, combined with the disease characteristics of AD. By using the convenience sampling method, a total of 201 patients with AD who had undergone surgery were selected as the research participants. The initial version of the scale was used for follow-up investigation, and the scale entries were evaluated and exploratory factor analysis carried out to form the formal version of the "postoperative self-management assessment scale for patients with aortic dissection." A total of 214 patients with AD after surgery were selected as the research participants. The formal version of the scale was used for follow-up investigation, and its reliability and validity were evaluated. Results The formal version of the scale had 6 dimensions and 35 entries. The Cronbach's α coefficient for the total scale was 0.908, the split-half reliability was 0.790, and the test-retest reliability after 2 weeks was 0.471. The content validity index of the total scale was 0.963. Exploratory factor analysis yielded six common factors, and the cumulative contribution rate of variance was 66.303%. Confirmatory factor analysis showed that except for the incremental fit index, Tucker-Lewis index, and comparative fit index >0.85, slightly lower than 0.90, χ 2/df <3, root mean square of approximation <0.08, parsimonious goodness-of-fit index, and parsimonious normed fit index >0.50; all other model fitting requirements were satisfied, indicating that the model fitting was acceptable. Conclusion We compiled the postoperative self-management assessment scale for patients with AD, which has demonstrated excellent reliability and validity and can be used as a tool to evaluate the postoperative self-management level in patients with aortic dissection.
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Affiliation(s)
- Li-Wei Zhang
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
| | - Yan-Chun Peng
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | - Qiong Pan
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
| | - Sai-Lan Li
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian350001, China
| | - Yan-Juan Lin
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian350001, China
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3
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Carbone A, Lamberti N, Manfredini R, Trimarchi S, Palladino R, Savriè C, Marra AM, Ranieri B, Crisci G, Izzo R, Esposito G, Cittadini A, Manfredini F, Rubenfire M, Bossone E. Cardiac rehabilitation and acute aortic dissection: understanding and addressing the evidence GAP a systematic review. Curr Probl Cardiol 2024; 49:102348. [PMID: 38246318 DOI: 10.1016/j.cpcardiol.2023.102348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
Despite guideline recommendations, strategies for implementing cardiac rehabilitation (CR) in patients with acute aortic dissection (AAD) are not well established with little evidence to risk stratify prudent and effective guidelines for the many required variables. We conducted a systematic review of studies (2004-2023) reporting CR following type A (TA) and type B (TB) AAD. Our review is limited to open surgical repair for TA and medical treatment for TB. A total of 5 studies were included (4 TA-AAD and 1 TB-AAD) in the qualitative analysis. In general, observational data included 311 patients who had an overall favorable effect of CR in AAD consisting of a modestly improved exercise capacity and work load during cycle cardiopulmonary exercise test (TB-AAD), and improved quality of life (QoL). No adverse events were reported during symptom limited pre-CR treadmill or cycle exercise VO2 max or CR. Given the overall potential in this high risk population without adequate evidence for important variables such as safe time from post-op to CR, intensity of training, duration and frequency of sessions and followup it is time for a moderate sized well designed safe trial for patients' post-op surgery for TA-AAD and medically treated TB-AAD who are treated with standardized evidence based medical therapy and physical therapy from discharge randomized to CR versus usual care. PROSPERO registry ID: CRD42023392896.
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Affiliation(s)
- Andreina Carbone
- Unit of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy; Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Caterina Savriè
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alberto M Marra
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Giulia Crisci
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Izzo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Melvyn Rubenfire
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Eduardo Bossone
- Department of Public Health, University of Naples Federico II, Naples, Italy.
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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Carbone A, Palladino R, Franzese M, Castaldo R, Ranieri B, Crisci G, Izzo R, Esposito G, Cittadini A, Schreurs B, van Kimmenade RRJ, Bossone E. Health-related quality of life in patients with aortic dissection: An unmet need. Curr Probl Cardiol 2024; 49:102138. [PMID: 38295010 DOI: 10.1016/j.cpcardiol.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 02/02/2024]
Abstract
Knowledge about the Health-related Quality of Life (HR-QoL) after Type A (TA-AAD) and Type B acute aortic dissection (TB-AAD) is still insufficient. Through this systematic review, including 22 studies (16 for TA-AAD and 6 TB-AAD -1998-2023), the entire literature on HR-QoL after surgical and/or endovascular and/or medical interventions has been investigated. In TA-AAD patients, despite overall SF-36 score was similar to the standard population, with > 80 years patients displaying a better emotional domain, the SF-12 was significant lower to controls in physical and mental well-being domains. Exercise-based cardiac rehabilitation improved HR-QoL. In TB-AAD, vitality and mental health SF-36 scores improved after thoracic endovascular aortic repair (TEVAR); long-term QoL was similar in the open surgery group compared to TEVAR. Overall, HR-QoL after AAD seems adequate irrespective of age or sex, except for some specific domains. Physical exercise and cardiac rehabilitation may improve HR-QoL in these patients. PROSPERO registry ID: CRD42023421130.
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Affiliation(s)
- Andreina Carbone
- Cardiology Unit, University Hospital "Luigi Vanvitelli", Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Monica Franzese
- Cardiology Unit, University Hospital "Luigi Vanvitelli", Naples, Italy
| | | | | | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bibi Schreurs
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Eduardo Bossone
- Department of Public Health, University "Federico II" of Naples, Naples, Italy.
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Koenders N, van Zetten H, Smulders M, Verra ML, van Kimmenade RRJ, van Brakel T, Eijsvogels TMH, Smith T. Improved Maximal Workload and Systolic Blood Pressure After Cardiac Rehabilitation Following Thoracic Aortic Repair: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2023; 43:419-426. [PMID: 37220027 DOI: 10.1097/hcr.0000000000000798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE It is of clinical importance to gain more knowledge about the risks and benefits of exercise in patients recovering from thoracic aortic repair. Therefore, the aim of this review was to perform a meta-analysis on changes in cardiorespiratory fitness, blood pressure, and the incidence of adverse events during cardiac rehabilitation (CR) in patients recovering from thoracic aortic repair. REVIEW METHODS We performed a systematic review and random-effects meta-analysis of outcomes before versus after outpatient CR in patients recovering from thoracic aortic repair. The study protocol was registered (PROSPERO CRD42022301204) and published. MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Overall certainty of evidence was scored with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). SUMMARY We included five studies with data from in total 241 patients. Data from one study could not be used in our meta-analysis because they were provided in a different unit of measure. Four studies with data of 146 patients were included in the meta-analysis. The mean maximal workload increased with 28.7 W (95% CI: 21.8-35.6 W, n = 146, low certainty of evidence). The mean systolic blood pressure during exercise testing increased with 25.4 mm Hg (95% CI: 16.6-34.3, n = 133, low certainty of evidence). No exercise-induced adverse events were reported. These outcomes indicate that CR seems beneficial and safe to improve exercise tolerance in patients recovering from thoracic aortic repair, although outcomes were based on data from a small, heterogeneous group of patients.
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Affiliation(s)
- Niek Koenders
- Departments of Rehabilitation (Dr Koenders) and Physiology (Dr Eijsvogels), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands (Mss van Zetten and Smulders and Dr Smith); Department of Physiotherapy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (Dr Verra); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (Dr van Kimmenade); and Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands (Dr van Brakel)
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7
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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8
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Gottlieb R, Arnskov K, Henriksen M, Prescott E, Rasmusen H, Dall CH. Hemodynamic Response in Ascending Aorta Surgery Patients during Moderate Intensity Resistance Training. TRANSLATIONAL SPORTS MEDICINE 2023; 2023:7616007. [PMID: 38654911 PMCID: PMC11022775 DOI: 10.1155/2023/7616007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 04/26/2024]
Abstract
Background In patients undergoing ascending aortic surgery (AAS), postsurgical physical exercise with a safe and effective exercise prescription is recommended. Resistance training is associated with blood pressure (BP) elevations that may increase the risk of new aortic dissection or rupture. However, the acute hemodynamic response to resistance training for this patient group is unknown. Aim The aim of this study was to investigate peak systolic BP (SBP) increases in AAS patients during moderate intensity resistance training. Methods SBP was measured continuously beat-to-beat with a noninvasive method during three sets of leg presses at moderate intensity. A 15-repetition maximum strength test was performed to estimate the maximal amount of resistance a participant could manage 15 times consecutively (equivalent to approximately 60-65% of their maximum strength). Results The study had 48 participants in total, i.e., 24 cases and 24 controls. Both groups consisted of 10 females (42%) and 14 males (58%). The case group had a mean age of 60.0 (SD ± 11.9) years and a mean of 16.3 months since surgery (minimum 4.4 and maximum 39.6 months). 22 of the 24 cases received antihypertensive medication. The median baseline BP was 119/74 mmHg among cases and 120/73 mmHg among controls. During the first set of leg presses, the median peak SBP was 152 mmHg, in the second set 154 mmHg, and in the third set 165 mmHg. Corresponding values in controls were 170 mmHg, 181 mmHg, and 179 mmHg. The highest peak SBP registered in an AAS patient was 190 mmHg and in any healthy control was 287 mmHg. Conclusion The findings indicate that AAS patients in control of their BP have the endurance to perform 3 sets of resistance training at moderate intensity as their SBP increases with a maximum of 39% from the baseline compared to the 51% increase in the control group.
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Affiliation(s)
- Rikke Gottlieb
- Department of Physical Therapy and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
- Department of Occupational Therapy and Physical Therapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Arnskov
- Department of Physical Therapy and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Marius Henriksen
- Department of Physical Therapy and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Hanne Rasmusen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Have Dall
- Department of Physical Therapy and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
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9
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Lin Y, Liang T, Zhang X, Peng Y, Li S, Huang X, Chen L. Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial. Clin Rehabil 2023; 37:1311-1321. [PMID: 37070198 DOI: 10.1177/02692155231169822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To determine the safety and efficacy of early postoperative mobilization in patients who have undergone surgical repair of acute type A aortic dissection. DESIGN Randomized controlled trial. SETTING Heart Medical Center. SUBJECTS Seventy-seven patients with acute type A aortic dissection were assessed. INTERVENTION Patients were randomly allocated into: (1) the control group (usual care) (n = 38) and (2) the intervention group (early goal-directed mobilization) (n = 39). MAIN MEASURES The primary outcome was the patient's functional status. The secondary outcomes included vital signs, serious adverse events, muscle strength, intensive care unit-acquired weakness, grip strength, duration of mechanical ventilation, length of stay, readmission rate, and health-related quality of life after 3 months. RESULTS The vital signs of the patients were within the tolerable ranges during the entire intervention. No serious exercise-related adverse events were observed in the intervention group. The Barthel Index score (P = 0.013), Medical Research Council score (P = 0.001), grip strength (P = 0.001), and health-related quality of life (P = 0.001) were higher in the intervention group. Intensive care unit acquired weakness (P = 0.019), duration of mechanical ventilation (P = 0.002), intensive care unit stay (P = 0.002), and total length of stay (P = 0.010) were lower in the intervention group. Patients in the intervention group had a higher physical health-related quality of life (P = 0.015) at 3 months post-surgery. There was no difference in readmission rates. CONCLUSIONS Delivery of early goal-directed mobilization in acute type A aortic dissection was safe and facilitated the recovery of daily living ability, shorter hospital stay, and improved quality of life after discharge.
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Affiliation(s)
- Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ting Liang
- Department of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xu Zhang
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yanchun Peng
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xizhen Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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10
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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11
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Hanna L, Jha R, Sounderajah V, Markar S, Gibbs R. Patient Reported Outcome Measures Used to Assess Quality of Life in Aortic Dissection: a Systematic Scoping Review using COSMIN Methodology. Eur J Vasc Endovasc Surg 2023; 66:343-350. [PMID: 37391013 DOI: 10.1016/j.ejvs.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To systematically identify all patient reported outcome measures (PROMs) (quality of life [QOL] instruments or other instrument/methodology) that have been used to date in aortic dissection (AD) and to explore how well these instruments evaluate QOL according to the Consensus based Standards for the selection of health Measurement Instruments (COSMIN) methodology or guideline. DATA SOURCES Embase, MEDLINE, PsycINFO, CINAHL, and Cochrane Library were search on 1st July 2022. REVIEW METHODS This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) and the COSMIN guidelines for performing systematic reviews of validated PROMs. Studies that reported on any aspect or domain of QOL using a PROM or other instrument or methodology on AD were included. Data synthesis, including psychometric property analysis and risk of bias assessment were performed according to COSMIN guidelines. RESULTS Forty-five studies, published between 1994 and 2021 reporting on 5 874 patients (mean age 63 years, 70.6% male), were included. A total of 39 PROMs were used, and three studies used semi-structured interviews. The majority (69%) of studies were in patients with type A aortic dissection (TAAD). The most common PROM used was the SF-36 (51%). Six studies evaluated one or more psychometric properties of a PROM. Only one of these studies was specifically designed as a validation study. No study reported on content validity. Internal consistency was the most evaluated psychometric property. No study evaluated all the psychometric properties according to COSMIN methodology. The methodological quality used to assess these PROMs was judged to be adequate or very good. CONCLUSION This review highlights the heterogeneity of PROMs or methods used to determine QOL in AD patients. The lack of research regarding a comprehensive evaluation of the psychometric properties of a PROM used in AD highlights the need for the development and validation of a dissection specific PROM. [PROSPERO registration no. CRD42022310477].
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Affiliation(s)
- Lydia Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
| | - Rama Jha
- School of Medicine, Imperial College London, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, London, UK; Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Richard Gibbs
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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12
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Jepsen LR, D'Oria M, Pedersen SF, Budtz-Lilly J. Efficacy and Safety of Exercise Testing and Rehabilitation for Aortic Dissection Patients: A SCOPING REVIEW. J Cardiopulm Rehabil Prev 2023; 43:156-161. [PMID: 36730592 DOI: 10.1097/hcr.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Although physical exercise has established benefits for long-term cardiovascular health, concern regarding further aortic events has limited the evidence for exercise among aortic dissection (AD) patients. The objective was to perform a scoping review of the current concepts and gaps in the literature regarding the benefit and safety of cardiovascular testing and rehabilitation among post-AD patients. REVIEW METHODS A scoping review of the literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Eligibility criteria included any studies with AD in relation to exercise rehabilitation or testing and physical or mental health. Electronic databases were queried for relevant studies (last queried, November 1, 2021). RESULTS Six observational studies were included with a total of 381 patients with AD, all of whom underwent surgical intervention. Study heterogeneity prevented data synthesis and a formal systematic review, although four dominant themes emerged: cardiovascular-related outcomes, aorta-related outcomes, quality of life (QoL), and serious adverse events. Patients with AD have reduced baseline physical capacity and QoL. Rehabilitation programs may increase both physical status and QoL. Rates of serious adverse rates are minimal yet poorly defined. CONCLUSIONS Within the context of apparent benefits from cardiovascular testing and rehabilitation for patients with AD who have undergone intervention, this scoping review highlights the need for increased comparative research specific to exercise among patients with AD and outcomes such as mortality and reinterventions.
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Affiliation(s)
- Lau Røge Jepsen
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Drs Jepsen, Pedersen, and Budtz-Lilly); and Division of Vascular and Endovascular Surgery, Cardiovascular Department, Trieste University Hospital Asuigi, Trieste, Italy (Dr D'Oria)
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13
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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14
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Saeed M, Malahfji M. Medical Management of Aortic Disease: If They Don't Need Surgery, What Do They Need? Methodist Debakey Cardiovasc J 2023; 19:70-77. [PMID: 36910548 PMCID: PMC10000319 DOI: 10.14797/mdcvj.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/13/2023] [Indexed: 03/09/2023] Open
Abstract
Management of aortic disease has evolved significantly over the past few decades. A preemptive diagnostic approach with a multidisciplinary team and shared decision-making has led to improved clinical outcomes. Surgery is the cornerstone of management for most aortic conditions; however, medical therapy is now an important adjunctive therapy in most if not all patients. Herein, we review the role and evidence behind medical management of patients with aortic disease.
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Affiliation(s)
- Mujtaba Saeed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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15
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 376] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
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- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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16
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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17
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Van Iterson EH, Laffin LJ, Svensson LG, Cho L. Individualized exercise prescription and cardiac rehabilitation following a spontaneous coronary artery dissection or aortic dissection. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac075. [PMID: 36518261 PMCID: PMC9741551 DOI: 10.1093/ehjopen/oeac075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Aims Prescribed aerobic-based exercise training is a low-risk fundamental component of cardiac rehabilitation (CR). Secondary prevention therapeutic strategies following a spontaneous coronary artery dissection (SCAD) or aortic dissection (AD) should include CR. Current exercise guidance for post-dissection patients recommends fundamental training components including target heart rate zones are not warranted. Omitting fundamental elements from exercise prescriptions risks safety and makes it challenging for both clinicians and patients to understand and implement recommendations in real-world practice. We review the principles of exercise prescription for CR, focusing on translating guidelines and evidence from well-studied high-risk CR populations to support the recommendation that exercise testing and individualized exercise prescription are important for patients following a dissection. Methods and results When patients self-perceive exercise intensity there is a tendency to underestimate intensities within metabolic domains that should be strictly avoided during routine exercise training following a dissection. However, exercise testing associated with CR enrolment has gained support and has not been linked to adverse events in optimally medicated post-dissection patients. Graded heart rate and blood pressure responses recorded throughout exercise testing provide key information for developing an exercise prescription. An exercise prescription that is reflective of medical history, medications, and cardiorespiratory fitness optimizes patient safety and yields improvements in blood pressure control and cardiorespiratory fitness, among other benefits. Conclusion This clinical practice and education article demonstrates how to develop and manage a CR exercise prescription for post-acute dissection patients that can be safe and effective for maintaining blood pressure control and improving cardiorespiratory fitness pre-post CR.
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Affiliation(s)
- Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH 44195, USA
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH 44195, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J4-1, Cleveland, OH 44195, USA
| | - Leslie Cho
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH 44195, USA
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18
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Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene. Life (Basel) 2022; 12:life12101511. [DOI: 10.3390/life12101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.
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Sheppard MB, Braverman AC. Sports Participation and Physical Activity in Individuals with Heritable Thoracic Aortic Disease and Aortopathy Conditions. Clin Sports Med 2022; 41:511-527. [PMID: 35710275 DOI: 10.1016/j.csm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The evaluation and management of athletes with HTAD and aortopathy conditions requires shared decision-making encompassing the underlying condition, family history, aortic diameter, and type and intensity of sports and exercise. Mouse models of thoracic aortic disease show that low-to-moderate-level aerobic exercise can maintain aortic architecture and attenuate pathologic aortic root dilation. Although controlled trials in human are lacking, recreational physical activities performed at a low-to-moderate aerobic pace are generally low risk for most individuals with aortopathy conditions. High-intensity, competitive, and contact sports or physical activities are generally prohibited in individuals with aortopathy conditions.
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Affiliation(s)
- Mary B Sheppard
- Department of Family and Community Medicine, Saha Aortic Center, University of Kentucky College of Medicine, 741 South Limestone Biomedical Biological Sciences Research Building Room B247, Lexington, KY 40536, USA; Department of Surgery, Saha Aortic Center, University of Kentucky College of Medicine, 741 South Limestone Biomedical Biological Sciences Research Building Room B247, Lexington, KY 40536, USA; Department of Physiology, Saha Aortic Center, University of Kentucky College of Medicine, 741 South Limestone Biomedical Biological Sciences Research Building Room B247, Lexington, KY 40536, USA. https://twitter.com/MaryBShep
| | - Alan C Braverman
- Marfan Syndrome and Aortopathy Clinic, Aortopathy and Master Clinician Fellowship Program, Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Box 8086, St. Louis, MO 63110, USA.
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20
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Bongarth CM. Kardiologische Rehabilitation nach herzchirurgischen Eingriffen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Is Exercise Blood Pressure Putting the Brake on Exercise Rehabilitation after Acute Type A Aortic Dissection Surgery? J Clin Med 2022; 11:jcm11102931. [PMID: 35629057 PMCID: PMC9146528 DOI: 10.3390/jcm11102931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/12/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Exercise is recommended to improve physical fitness in patients recovering from acute type A aortic dissection (ATAAD). However, surgery corrects the diseased blood vessels and reduces the risk of ATAAD, but it does not redefine a safe exercise blood pressure (BP) threshold. This review aimed to discuss whether the safe threshold of exercise BP can be upregulated after ATAAD surgery to increase exercise intensity with additional benefits. (2) Data sources: The PubMed databases were searched with the keywords “type A acute aortic dissection surgery”, “exercise”, “BP”, “stress”, and variations of these terms. (3) Study selection: Data from clinical trials, guidelines, and recent reviews were selected for review. (4) Results: Regular exercise can be considered a cardioprotective intervention for aortic dissection patients by attenuating hemodynamic responses at rest and during exercise. Previous studies have mainly focused on moderate-intensity aerobic exercise. In practice, the exercise systolic BP of some patients was higher than 160 mm Hg without adverse events, which indicates that the training intensity may be underestimated for patients after ATAAD surgery. Limited studies suggest a light-to-moderate resistance training for selected patients because it may cause a greater increase in BP. (5) Conclusions: Moderate-intensity continuous aerobic exercise supplemented by low-intensity resistance training is appropriate for cardiac rehabilitation after ATAAD surgery. The BP increase based on the normal exercise BP response, corresponding to the moderate-intensity is relatively safe. For high-risk post-ATAAD patients, considering the overall volume of training, personalizing the exercise regimen to remain within “safe” BP limits, and avoiding excessive fluctuations in BP should be the primary considerations for exercise training.
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22
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Zhou N, Fortin G, Balice M, Kovalska O, Cristofini P, Ledru F, Mampuya WM, Iliou MC. Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection. J Clin Med 2022; 11:jcm11082107. [PMID: 35456200 PMCID: PMC9025085 DOI: 10.3390/jcm11082107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/10/2022] Open
Abstract
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.
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Affiliation(s)
- Na Zhou
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Gabriel Fortin
- Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; (G.F.); (W.M.M.)
| | - Maria Balice
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Oksana Kovalska
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Pascal Cristofini
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Francois Ledru
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Warner M. Mampuya
- Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; (G.F.); (W.M.M.)
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
- Correspondence:
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Nakamura K, Ohbe H, Uda K, Matsui H, Yasunaga H. Effectiveness of early rehabilitation following aortic surgery: a nationwide inpatient database study. Gen Thorac Cardiovasc Surg 2022; 70:721-729. [PMID: 35182302 DOI: 10.1007/s11748-022-01786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Exercise immediately after aortic surgery is controversial with limited evidence. The present study aimed to assess whether early rehabilitation commencing within 3 days of aortic surgery improves physical functions at discharge more than usual care in patients after aortic surgery. METHODS We used the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database from more than 1600 acute care hospitals that covers approximately 75% of all intensive care unit (ICU) beds in Japan. We identified patients who underwent open or endovascular aortic surgery and were admitted to the ICU between July 2010 and March 2018. Patients beginning rehabilitation within 3 days of aortic surgery were defined as the early rehabilitation group and the remaining patients as the usual care group. We used inverse probability of treatment weighting analyses to compare outcomes between the two groups. RESULTS Among 121,024 eligible patients, there were 44,746 (37.0%) in the early rehabilitation group and 76,278 (63.0%) in the usual care group. In inverse probability of treatment weighting analyses, Barthel index scores at discharge were significantly higher in the early rehabilitation group than in the usual care group (difference, 4.0; 95% confidence interval, 2.8-5.2). The early rehabilitation group had significantly lower in-hospital mortality, lower total hospitalization costs, shorter ICU stay, and shorter hospital stay than the usual care group. CONCLUSION Early rehabilitation within 3 days of aortic surgery was associated with improved physical functions at discharge, shorter ICU and hospital stays, and lower hospitalization costs without increased mortality.
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Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki, 317-0077, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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24
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Schwaab B, Rauch B, Völler H, Benzer W, Schmid JP. Beyond randomised studies: recommendations for cardiac rehabilitation following repair of thoracic aortic aneurysm or dissection. Eur J Prev Cardiol 2022; 28:e17-e19. [PMID: 32646302 DOI: 10.1177/2047487320936782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Heinz Völler
- Faculty of Health Science, University of Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Germany
| | - Werner Benzer
- Department of Cardiology, Montafon Rehabilitation Centre, Austria
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25
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WANG J, XIE J, MENG X, GONG X. Comparison of CT and MRI in imaging diagnosis of aortic dissection. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Junmin XIE
- Affiliated Hospital of Hebei University, China
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26
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Cardiopulmonary Exercise Testing Following Open Repair for a Proximal Thoracic Aortic Aneurysm or Dissection. J Cardiopulm Rehabil Prev 2021; 40:108-115. [PMID: 31478921 DOI: 10.1097/hcr.0000000000000446] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE There are limited data on cardiopulmonary exercise testing (CPX) and cardiorespiratory fitness (CRF), following open repair for a proximal thoracic aortic aneurysm or dissection. The aim was to evaluate serious adverse events, abnormal CPX event rate, CRF (peak oxygen uptake, (Equation is included in full-text article.)O2peak), and blood pressure. METHODS Patients were retrospectively identified from cardiac rehabilitation participation or prospectively enrolled in a research study and grouped by phenotype: (1) bicuspid aortic valve/thoracic aortic aneurysm, (2) tricuspid aortic valve/thoracic aortic aneurysm, and (3) acute type A aortic dissection. RESULTS Patients (n = 128) completed a CPX a median of 2.9 mo (interquartile range: 1.8, 3.5) following repair. No serious adverse events were reported, although 3 abnormal exercise tests (2% event rate) were observed. Eighty-one percent of CPX studies were considered peak effort (defined as respiratory exchange ratio of ≥1.05). Median measured (Equation is included in full-text article.)O2peak was <36% predicted normative values (19.2 mL·kgmin vs 29.3 mLkgmin, P < .0001); the most marked impairment in (Equation is included in full-text article.)O2peak was observed in the acute type A aortic dissection group (<40% normative values), which was significantly different from other groups (P < .05). Peak exercise systolic and diastolic blood pressures were 160 mm Hg (144, 172) and 70 mm Hg (62, 80), with no differences noted between groups. CONCLUSIONS We observed no serious adverse events with an abnormal CPX event rate of only 2% 3 mo following repair for a proximal thoracic aortic aneurysm or dissection. (Equation is included in full-text article.)O2peak was reduced among all patient groups, especially the acute type A aortic dissection group, which may be clinically significant, given the well-established prognostic importance of reduced cardiorespiratory fitness.
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27
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Norton EL, Wu KHH, Rubenfire M, Fink S, Sitzmann J, Hobbs RD, Saberi S, Willer CJ, Yang B, Hornsby WE. Cardiorespiratory Fitness After Open Repair for Acute Type A Aortic Dissection - A Prospective Study. Semin Thorac Cardiovasc Surg 2021; 34:827-839. [PMID: 34102292 PMCID: PMC8645655 DOI: 10.1053/j.semtcvs.2021.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/11/2022]
Abstract
Cardiorespiratory fitness (as measured by peak oxygen consumption [VO2peak]) is an independent predictor of cardiovascular disease and all-cause mortality. Limited data exist on VO2peak following repair for an acute type A aortic dissection (ATAAD) or proximal thoracic aortic aneurysm (pTAA). This study prospectively evaluated VO2peak, functional capacity, and health-related quality of life (HR-QOL) following open repair. Participants with a history of an ATAAD (n = 21) or pTAA (n = 43) performed cardiopulmonary exercise testing (CPX), 6-minute walk testing, and HR-QOL at 3 (early) and 15 (late) months following open repair. The median age at time of surgery was 55-years-old and 60-years-old in the ATAAD and pTAA groups, respectively. Body mass index significantly increased between early and late timepoints for both ATAAD (p = 0.0245, 56% obese) and pTAA groups (p = 0.0045, 54% obese). VO2peak modestly increased by 0.8 mLO2·kg-1·min-1 within the ATAAD group (p = 0.2312) while VO2peak significantly increased by 2.2 mLO2·kg-1·min-1 within the pTAA group (p = 0.0003). Anxiety significantly decreased in the ATAAD group whereas functional capacity and HR-QOL metrics (social roles and activities, physical function) significantly improved in the pTAA group (p values < 0.05). There were no serious adverse events during CPX. Cardiorespiratory fitness among the ATAAD group remained 36% below predicted normative values >1 year after repair. CPX should be considered post-operatively to evaluate exercise tolerance and blood pressure response to determine whether mild-to-moderate aerobic exercise should be recommended to reduce future risk of morbidity and mortality.
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Affiliation(s)
| | - Kuan-Han H Wu
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Melvyn Rubenfire
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Samantha Fink
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Jacob Sitzmann
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Reilly D Hobbs
- Department of Cardiac Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Cristen J Willer
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan; Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan; Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan.
| | - Whitney E Hornsby
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan.
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28
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Deng MX, Tam DY, Fremes SE. Commentary: A Puzzle With Many "Moving" Parts. Semin Thorac Cardiovasc Surg 2021; 34:840-841. [PMID: 34098117 DOI: 10.1053/j.semtcvs.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Mimi X Deng
- Divison of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Divison of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Divison of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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29
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Rauch B, Salzwedel A, Bjarnason-Wehrens B, Albus C, Meng K, Schmid JP, Benzer W, Hackbusch M, Jensen K, Schwaab B, Altenberger J, Benjamin N, Bestehorn K, Bongarth C, Dörr G, Eichler S, Einwang HP, Falk J, Glatz J, Gielen S, Grilli M, Grünig E, Guha M, Hermann M, Hoberg E, Höfer S, Kaemmerer H, Ladwig KH, Mayer-Berger W, Metzendorf MI, Nebel R, Neidenbach RC, Niebauer J, Nixdorff U, Oberhoffer R, Reibis R, Reiss N, Saure D, Schlitt A, Völler H, von Känel R, Weinbrenner S, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1. J Clin Med 2021; 10:2192. [PMID: 34069561 PMCID: PMC8161282 DOI: 10.3390/jcm10102192] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. METHODS The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the "Association of the Scientific Medical Societies in Germany" (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. RESULTS Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on "treatment intensity" including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. CONCLUSIONS These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.
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Affiliation(s)
- Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany
- Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, D-50937 Köln, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Karin Meng
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, D-97078 Würzburg, Germany;
| | | | | | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Bernhard Schwaab
- Curschmann Klinik Dr. Guth GmbH & Co KG, D-23669 Timmendorfer Strand, Germany;
| | | | - Nicola Benjamin
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany;
| | - Christa Bongarth
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, D-14471 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Hans-Peter Einwang
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Johannes Falk
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany;
| | - Stephan Gielen
- Klinikum Lippe, Standort Detmold, D-32756 Detmold, Germany;
| | - Maurizio Grilli
- Universitätsbibliothek, Universitätsmedizin Mannheim, D-68167 Mannheim, Germany;
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Manju Guha
- Reha-Zentrum am Sendesaal, D-28329 Bremen, Germany;
| | - Matthias Hermann
- Klinik für Kardiologie, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland;
| | - Eike Hoberg
- Wismarstraße 13, D-24226 Heikendorf, Germany;
| | - Stefan Höfer
- Universitätsklinik für Medizinische Psychologie und Psychotherapie, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria;
| | - Harald Kaemmerer
- Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Klinik der Technischen Universität München, D-80636 München, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) Langerstraße 3, D-81675 Munich, Germany;
| | - Wolfgang Mayer-Berger
- Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, D-42799 Leichlingen, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine University, Werdener Straße. 4, D-40227 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen der Stadt Radolfzell, D-73851 Radolfzell, Germany;
| | - Rhoia Clara Neidenbach
- Institut für Sportwissenschaft, Universität Wien, Auf der Schmelz 6 (USZ I), AU-1150 Wien, Austria;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Uwe Nixdorff
- EPC GmbH, European Prevention Center, Medical Center Düsseldorf, D-40235 Düsseldorf, Germany;
| | - Renate Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, D-80992 München, Germany;
| | - Rona Reibis
- Kardiologische Gemeinschaftspraxis Am Park Sanssouci, D-14471 Potsdam, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, Ulmenallee 5-12, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Axel Schlitt
- Paracelsus Harz-Klinik Bad Suderode GmbH, D-06485 Quedlinburg, Germany;
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Roland von Känel
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland;
| | - Susanne Weinbrenner
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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Aicher BO, Zhang J, Muratoglu SC, Galisteo R, Arai AL, Gray VL, Lal BK, Strickland DK, Ucuzian AA. Moderate aerobic exercise prevents matrix degradation and death in a mouse model of aortic dissection and aneurysm. Am J Physiol Heart Circ Physiol 2021; 320:H1786-H1801. [PMID: 33635167 PMCID: PMC8163659 DOI: 10.1152/ajpheart.00229.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is a deadly disease characterized by intimal disruption induced by hemodynamic forces of the circulation. The effect of exercise in patients with TAAD is largely unknown. β-Aminopropionitrile (BAPN) is an irreversible inhibitor of lysyl oxidase that induces TAAD in mice. The objective of this study was to investigate the effect of aerobic exercise on BAPN-induced TAAD. Upon weaning, mice were given either BAPN-containing water or standard drinking water and subjected to either conventional cage activity (BAPN-CONV) or forced treadmill exercise (BAPN-EX) for up to 26 wk. Mortality was 23.5% (20/85) for BAPN-CONV mice versus 0% (0/22) for BAPN-EX mice (hazard ratio 3.8; P = 0.01). BAPN induced significant elastic lamina fragmentation and intimal-medial thickening compared with BAPN-untreated controls, and aneurysms were identified in 50% (5/10) of mice that underwent contrast-enhanced CT scanning. Exercise significantly decreased BAPN-induced wall thickening, calculated circumferential wall tension, and lumen diameter, with 0% (0/5) of BAPN-EX demonstrating chronic aortic aneurysm formation on CT scan. Expression of selected genes relevant to vascular diseases was analyzed by qRT-PCR. Notably, exercise normalized BAPN-induced increases in TGF-β pathway-related genes Cd109, Smad4, and Tgfβr1; inflammation-related genes Vcam1, Bcl2a1, Ccr2, Pparg, Il1r1, Il1r1, Itgb2, and Itgax; and vascular injury- and response-related genes Mmp3, Fn1, and Vwf. Additionally, exercise significantly increased elastin expression in BAPN-treated animals compared with controls. This study suggests that moderate aerobic exercise may be safe and effective in preventing the most devastating outcomes in TAAD.NEW & NOTEWORTHY Moderate aerobic exercise was shown to significantly reduce mortality, extracellular matrix degradation, and thoracic aortic aneurysm and dissection formation associated with lysyl oxidase inhibition in a mouse model. Gene expression suggested a reversal of TGF-β, inflammation, and extracellular matrix remodeling pathway dysregulation, along with augmented elastogenesis with exercise.
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MESH Headings
- Aminopropionitrile
- Aortic Dissection/chemically induced
- Aortic Dissection/metabolism
- Aortic Dissection/pathology
- Aortic Dissection/therapy
- Animals
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/chemically induced
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/therapy
- Aortic Rupture/chemically induced
- Aortic Rupture/metabolism
- Aortic Rupture/pathology
- Aortic Rupture/prevention & control
- Dilatation, Pathologic
- Disease Models, Animal
- Disease Progression
- Exercise Therapy
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Extracellular Matrix Proteins/metabolism
- Gene Expression Regulation
- Hemodynamics
- Male
- Mice, Inbred C57BL
- Proteolysis
- Signal Transduction
- Vascular Remodeling
- Mice
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Affiliation(s)
- Brittany O Aicher
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jackie Zhang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Selen C Muratoglu
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rebeca Galisteo
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
| | - Allison L Arai
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brajesh K Lal
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Affairs Medical Center, Vascular Service, Baltimore, Maryland
| | - Dudley K Strickland
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Areck A Ucuzian
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Affairs Medical Center, Vascular Service, Baltimore, Maryland
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Delsart P, Delahaye C, Devos P, Domanski O, Azzaoui R, Sobocinski J, Juthier F, Vincentelli A, Rousse N, Mugnier A, Soquet J, Loobuyck V, Koussa M, Modine T, Jegou B, Bical A, Hysi I, Fabre O, Pontana F, Matran R, Mounier-Vehier C, Montaigne D. Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients. Clin Cardiol 2020; 44:252-260. [PMID: 33381882 PMCID: PMC7852169 DOI: 10.1002/clc.23537] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although recommendations encourage daily moderate activities in post aortic dissection, very little data exists regarding cardiopulmonary exercise testing (CPET) to personalize those patient's physical rehabilitation and assess their cardiovascular prognosis. DESIGN We aimed at testing the prognostic insight of CPET regarding aortic and cardiovascular events by exploring a prospective cohort of patients followed-up after acute aortic dissection. METHODS Patients referred to our department after an acute (type A or B) aortic dissection were prospectively included in a cohort between September 2012 and October 2017. CPET was performed once optimal blood pressure control was obtained. Clinical follow-up was done after CPET for new aortic event and major cardio-vascular events (MCE) not directly related to the aorta. RESULTS Among the 165 patients who underwent CPET, no adverse event was observed during exercise testing. Peak oxygen pulse was 1.46(1.22-1.84) mlO2/beat, that is, 97 (83-113) % of its predicted value, suggesting cardiac exercise limitation in a population under beta blockers (92% of the population). During a follow-up of 39(20-51) months from CPET, 42 aortic event recurrences and 22 MCE not related to aorta occurred. Low peak oxygen pulse (<85% of predicted value) was independently predictive of aortic event recurrence, while low peak oxygen uptake (<70% of predicted value) was an independent predictor of MCE occurrence. CONCLUSION CPET is safe in postaortic dissection patients should be used to not only to personalize exercise rehabilitation, but also to identify those patients with the highest risk for new aortic events and MCE not directly related to aorta.
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Affiliation(s)
| | | | - Patrick Devos
- University of Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | | | | | - Jonathan Sobocinski
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1008, Lille, France
| | - Francis Juthier
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Andre Vincentelli
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Natacha Rousse
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | | | - Jerome Soquet
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Valentin Loobuyck
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | | | | | - Bruno Jegou
- CHU Lille, Institut Coeur-Poumon, Lille, France
| | | | - Ilir Hysi
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, Lens, France
| | - Olivier Fabre
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, Lens, France
| | - François Pontana
- CHU Lille, Institut Coeur-Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | | | | | - David Montaigne
- CHU Lille, Department of Clinical Physiology & echocardiography, Univ. Lille, Inserm U1011-EGID, Lille, France
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33
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Huang J, Zhang H, Tan X, Hu M, Shen B. Exercise restores impaired endothelium-derived hyperpolarizing factor-mediated vasodilation in aged rat aortic arteries via the TRPV4-K Ca2.3 signaling complex. Clin Interv Aging 2019; 14:1579-1587. [PMID: 31564840 PMCID: PMC6731547 DOI: 10.2147/cia.s220283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background Aging leads to structural and functional changes in the vasculature characterized by arterial endothelial dysfunction and stiffening of large elastic arteries and is a predominant risk factor for cardiovascular disease, the leading cause of morbidity and mortality in modern societies. Although exercise reduces the risk of many age-related diseases, including cardiovascular disease, the mechanisms underlying the beneficial effects of exercise on age-related endothelial function fully elucidated. Purpose The present study explored the effects of exercise on the impaired endothelium-derived hyperpolarizing factor (EDHF)–mediated vasodilation in aged arteries and on the involvement of the transient receptor potential vanilloid 4 (TRPV4) channel and the small-conductance calcium-activated potassium (KCa2.3) channel signaling in this process. Methods Male Sprague-Dawley rats aged 19–21 months were randomly assigned to a sedentary group or to an exercise group. Two-month-old rats were used as young controls. Results We found that TRPV4 and KCa2.3 isolated from primary cultured rat aortic endothelial cells pulled each other down in co-immunoprecipitation assays, indicating that the two channels could physically interact. Using ex vivo functional arterial tension assays, we found that EDHF-mediated relaxation induced by acetylcholine or by the TRPV4 activator GSK1016790A was markedly decreased in aged rats compared with that in young rats and was significantly inhibited by TRPV4 or KCa2.3 blockers in both young and aged rats. However, exercise restored both the age-related and the TRPV4-mediated and KCa2.3-mediated EDHF responses. Conclusion These results suggest an important role for the TRPV4-KCa2.3 signaling undergirding the beneficial effect of exercise to ameliorate age-related arterial dysfunction.
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Affiliation(s)
- Junhao Huang
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Department of Sports and Health, Guangzhou Sport University, Guangzhou, Guangdong, People's Republic of China
| | - Hai Zhang
- Department of Physical Education, Guangdong University of Petrochemical Technology, Maoming, Guangdong, People's Republic of China
| | - Xianming Tan
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Department of Sports and Health, Guangzhou Sport University, Guangzhou, Guangdong, People's Republic of China
| | - Min Hu
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Department of Sports and Health, Guangzhou Sport University, Guangzhou, Guangdong, People's Republic of China
| | - Bing Shen
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, People's Republic of China
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Spanos K, Tsilimparis N, Kölbel T. Exercise after Aortic Dissection: to Run or Not to Run. Eur J Vasc Endovasc Surg 2018; 55:755-756. [DOI: 10.1016/j.ejvs.2018.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/09/2018] [Indexed: 01/16/2023]
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Blokzijl F, Dieperink W, Keus F, Reneman MF, Mariani MA, van der Horst IC. Cardiac rehabilitation for patients having cardiac surgery: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:817-829. [PMID: 29616525 DOI: 10.23736/s0021-9509.18.10462-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is recommended for all cardiac patients including patients after cardiac surgery. Since the effect of CR after cardiac surgery has not been well established yet, we conducted a systematic review on the effects of CR for patients after cardiac surgery compared to treatment as usual. EVIDENCE ACQUISITION A systematic review of randomized clinical trials (RCTs), quasi-randomized and prospective observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE was undertaken until October 18th, 2017. Adults after any kind of cardiac surgery were included. Primary outcome was all-cause mortality, other outcomes were serious adverse events, health-related quality of life, work participation, functioning and costs/cost-effectiveness. Risk of bias was evaluated, and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. EVIDENCE SYNTHESIS Eighteen RCTs and 15 observational studies were included. Low risk of bias was only observed in one observational study. Meta-analysis of RCTs suggested no significant difference of CR compared to control on mortality (random-effects relative risk (RR) 0.93 (95% CI: 0.40-1.81), while observational studies suggested statistically significant beneficial effect associated with CR (random-effects RR=0.49, 95% CI: 0.35 - 0.68). CR did not significantly affect any of the other outcomes. Due to the limited data TSA could not be performed. CONCLUSIONS The body of evidence does not allow us to reach any reliable conclusions about the effectiveness of CR following cardiac surgery. Future trials need to be conducted with low risks of bias and clearly defined outcomes.
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Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands -
| | - Willem Dieperink
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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