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Amedro P, Gavotto A, Huguet H, Souilla L, Huby AC, Matecki S, Cadene A, De La Villeon G, Vincenti M, Werner O, Bredy C, Lavastre K, Abassi H, Cohen S, Hascoet S, Dauphin C, Chalard A, Dulac Y, Souletie N, Bouvaist H, Douchin S, Lachaud M, Ovaert C, Soulatges C, Combes N, Thambo JB, Iriart X, Bajolle F, Bonnet D, Ansquer H, Delpey JG, Cohen L, Picot MC, Guillaumont S. Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial. Eur Heart J 2024; 45:1458-1473. [PMID: 38430485 PMCID: PMC11032713 DOI: 10.1093/eurheartj/ehae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND AND AIMS Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD. METHODS The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health. RESULTS The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference -0.7 kg/m2 (95% CI -1.3; -0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent. CONCLUSIONS This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.
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Affiliation(s)
- Pascal Amedro
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Arthur Gavotto
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Luc Souilla
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne-Cecile Huby
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Stefan Matecki
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne Cadene
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Gregoire De La Villeon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Oscar Werner
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Charlene Bredy
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Fontfroide Cardiac Rehabilitation Center, 1800 rue de Saint-Priest, 34097 Montpellier, France
| | - Kathleen Lavastre
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Sarah Cohen
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Sebastien Hascoet
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Claire Dauphin
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aurelie Chalard
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Yves Dulac
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Nathalie Souletie
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Helene Bouvaist
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Stephanie Douchin
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Matthias Lachaud
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France
| | - Camille Soulatges
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France
| | - Nicolas Combes
- Pediatric and Congenital Cardiology Department, Pasteur Clinic, Toulouse, France
| | - Jean-Benoit Thambo
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Xavier Iriart
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Fanny Bajolle
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital, Paris, France
| | - Damien Bonnet
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital, Paris, France
| | - Helene Ansquer
- Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France
| | - Jean-Guillaume Delpey
- Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France
| | - Laurence Cohen
- Fetal, Pediatric and Congenital Private Practice, 8 rue du Conseil de l'Europe, 91300 Massy, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
- Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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Baruteau AE, Vergnat M, Kalfa D, Delpey JG, Ly M, Capderou A, Lambert V, Belli E. Long-term outcomes of the arterial switch operation for transposition of the great arteries and ventricular septal defect and/or aortic arch obstruction. Interact Cardiovasc Thorac Surg 2016; 23:240-6. [PMID: 27141085 DOI: 10.1093/icvts/ivw102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/08/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Long-term outcomes after the arterial switch operation (ASO) for complex transposition of the great arteries (TGA) should be clarified. METHODS A retrospective study was conducted in patients operated on between 1982 and 1998. Overall 220 postoperative survivors, 79.1% with a ventricular septal defect, 13.2% with multiple ventricular septal defects, and 29.1% with aortic arch obstruction, were followed for 17 years (0-28 years). RESULTS The conditional survival rate was 96.7% [95% confidence interval (CI): 94.4-99.1] at 25 years. Late sudden death occurred in 2 asymptomatic patients. The cumulative incidence rate of death or reinterventions was 3.8% (95% CI: 2.9-4.8) at 25 years, with age at ASO <10 days and aortic regurgitation at discharge identified as independent risk factors. The cumulative incidence rate of neoaortic regurgitation was 41.6% (95% CI: 20.5-62.8) at 25 years with an aorto-pulmonary diameter mismatch at the time of the ASO, age at ASO <10 days and aortic regurgitation at discharge identified as independent risk factors. At the last follow-up, 53 patients (24.1%) had neoaortic root dilatation with an aortic sinus z-score ≥3 and 6 of them had a Bentall operation at a median delay of 14.1 years since the ASO. The only independent factors for neoaortic root dilatation were male sex and an aorto-pulmonary diameter mismatch at the time of the ASO. CONCLUSIONS Despite a continual rate of reinterventions, long-term survival and cardiovascular outcome are excellent after ASO for complex TGA. Dilatation of the neoaortic root and neoaortic regurgitation may be observed with time and 2 late sudden deaths occurred, justifying a close follow-up in all patients.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France Department of Pediatric Cardiac Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Mathieu Vergnat
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France
| | - David Kalfa
- Department of Pediatric Cardiac Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Jean-Guillaume Delpey
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France
| | - Mohamed Ly
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France
| | - André Capderou
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France
| | - Virginie Lambert
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France
| | - Emre Belli
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France
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