Savage Patrick D, Rengo Jason L, Menzies Keon E, Ades Philip A
Cardiac Rehabilitation and Prevention, Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont.
J Cardiopulm Rehabil Prev. 2015 Jul-Aug;35(4):231-7. doi: 10.1097/HCR.0000000000000104.
Coronary artery bypass graft (CABG) surgery patients participating in cardiac rehabilitation (CR) experience improvements in aerobic fitness, but there has been little study of outcomes for heart valve (HV) surgical patients. The primary aims of this study were to evaluate baseline peak aerobic capacity for HV patients participating in CR and to compare outcomes between HV and CABG patients.
Five hundred seventy-six consecutive patients who underwent HV surgery (n = 125), HV plus CABG surgery (n = 57), or CABG surgery (n = 394), all with classic sternotomy and enrolled in CR, were prospectively studied. Changes in outcomes were assessed for individuals who completed CR (n = 313).
HV patients were significantly older and had a greater percentage of females than the CABG-only group. Combining HV and HV + CABG groups, valvular disorders included 134 mitral, 39 aortic, and 8 combined abnormalities (mitral and aortic). For the entire cohort, the mean number of CR exercise sessions attended was 23.6 ± 11.7. Peak oxygen uptake ((Equation is included in full-text article.)) increased 19.5% from 17.4 ± 4.4 to 20.8 ± 5.5 mLO2·kg(-1)·min(-1) (P < .0001). Improvement in peak (Equation is included in full-text article.)with CR exercise training was similar between the 3 groups of patients. Within the group of patients who had HV surgery, percentage change in peak (Equation is included in full-text article.)was not significantly different between the 3 types of valvular abnormalities (ie, mitral [19.2%], aortic [24.4%], and mitral + aortic [21.9%]).
HV surgery patients achieve similar improvement in aerobic fitness from participating in CR exercise training as individuals who had CABG. The observed improvements in aerobic fitness are similar, regardless of the type of valve abnormality or whether CABG was performed concurrently.
接受冠状动脉旁路移植术（CABG）并参与心脏康复（CR）的患者有氧适能得到改善，但针对心脏瓣膜（HV）手术患者结局的研究较少。本研究的主要目的是评估参与CR的HV患者的基线峰值有氧能力，并比较HV患者与CABG患者的结局。
对576例连续接受HV手术（n = 125）、HV加CABG手术（n = 57）或CABG手术（n = 394）的患者进行前瞻性研究，所有患者均采用经典胸骨切开术并参与CR。对完成CR的个体（n = 313）的结局变化进行评估。
HV患者比单纯CABG组患者年龄显著更大，女性比例更高。将HV组和HV + CABG组合并，瓣膜疾病包括134例二尖瓣病变、39例主动脉瓣病变和8例联合异常（二尖瓣和主动脉瓣）。对于整个队列，参加CR运动课程的平均次数为23.6±11.7次。峰值摄氧量（（公式包含在全文中。））从17.4±4.4增加到20.8±5.5 mL O2·kg-1·min-1，增幅为19.5%（P <.0001）。三组患者通过CR运动训练在峰值（（公式包含在全文中。））方面的改善相似。在接受HV手术的患者组中，三种瓣膜异常类型（即二尖瓣[19.2%]、主动脉瓣[24.4%]和二尖瓣+主动脉瓣[21.9%]）之间峰值（（公式包含在全文中。））的百分比变化无显著差异。
HV手术患者通过参与CR运动训练在有氧适能方面取得的改善与接受CABG的患者相似。无论瓣膜异常类型如何或是否同时进行CABG，观察到的有氧适能改善相似。
