Low-risk exercise after Bicuspid aortic valve aneurysm repair

A new report suggests that patients who undergo surgery to repair a bicuspid aortic aneurysm have a reduced risk of future aneurysm events even if they participate in endurance exercises.

The report describes a case series of 21 subjects who participated in multiple endurance events for an average of 8 years after this surgery without any aneurysm events.

“The most important message is that in this select group of patients who have had bicuspid aortic valve aneurysms repaired, endurance exercise appears to be low risk,” said study co-author Alan Braverman, MD, a physician at the University of Washington College. Said Medicine, St. Louis, Missouri theheart.org | Medscape Heart.

The case series was reported in a letter to heart gamma Posted online June 8.

Braverman noted that individuals with hereditary thoracic aneurysm diseases are generally advised to avoid endurance exercise due to concerns about aneurysm events that can affect the entire aorta.

However, patients with bicuspid aortic valve-associated aneurysms may be different because in these patients the aortic disease is more specific and the problem may be resolved with aneurysm repair surgery.

Braverman explained that most people have three leaflets on the aortic valve but about 1% of the population have two leaflets – they have a bicuspid valve.

“In people with a bicuspid valve, the blood flow does not pass completely through the middle of the aorta, but rather favors one side or the other. Over many years, this may deteriorate the elastic tissue in the wall of the aorta at some point, causing dilatation The aorta and aneurysm formation”. This condition is well established, Braverman noted, and these patients usually undergo surgical removal of the aneurysm.

“In patients with bicuspid aortic aneurysm, the injury is a small, constant portion of the ascending aorta,” he added. “Once the aneurysm is repaired, it should not occur again, and so these patients may have a lower risk of future events with endurance exercise. But there is very little data on whether this is really the case.”

For the current study, Braverman and colleague Andrew Lai, MD, also of the University of Washington School of Medicine, partnered with the Ironheart Foundation, which encourages heart patients to lead an active lifestyle, to identify individuals who had a bicuspid aortic valve and had an aortic valve. Surgical repair of thoracic aortic aneurysm and later return to endurance exercise.

They recruited 21 of these individuals (mean age, 53; 80% male) who were followed up for 8 years after thoracic aortic aneurysm surgery. Clinical data, exercise regimens, endurance competitions, and imaging data were obtained from medical records, questionnaires, and telephone calls. Echocardiography, CT, and MRI reports from preoperative to last follow-up were reviewed.

The results showed that the athletes resumed endurance exercise or competition an average of 5.7 months after thoracic aortic aneurysm repair. Athletes have cumulatively completed nearly 300 endurance events including marathons, triathlons, and ironmans.

Most of the participants (76%) exercised 4 to 6 days a week, and five people exercised daily. Athletes exercise an average of 1.4 hours a day. All but one of the subjects reported that they did not perform any intense weight training.

At the last clinical follow-up, 8 years after thoracic aortic aneurysm resection, all 21 individuals were actively exercising and competing, and no adverse outcomes were reported.

Braverman noted that clinical guidelines are currently very restrictive about exercise after any aneurysmectomy.

“There have been some anecdotal reports of professional athletes choosing to return to their sports after bicuspid aortic valve aneurysm surgery, but apart from that, there is no other data. We wanted to determine the outcomes in a larger group.”

He said they conducted the current study because a patient with this condition whose aneurysm had been repaired wanted to know if he could participate in the endurance cycle cycle, but they were unable to find any information about the safety of endurance exercise in such patients in the literature.

“Our results are very reassuring and indicate a reduced risk of further aneurysm events in these patients even when they participate in endurance exercises,” he commented.

But he stressed that bicuspid aortic aneurysms are different from other types of aortic aneurysms, and these findings do not apply to other types of aortic aneurysms.

“In other types of hereditary aneurysms such as Marfan syndrome, the entire aorta is at risk, so even if one aneurysm is repaired, there is still a risk of another aneurysm developing in a different part of the aorta,” Braverman explained.

He said the information from this study will help clinicians advise patients who have had bicuspid aortic valve aneurysm surgery and who wish to return to exercise.

“We previously thought it might be safe but there is no data to support this assumption, which has led to different advice.”

When asked if this study was enough to indicate that endurance exercises are safe for these individuals, Braverman replied, “While 21 patents isn’t a huge amount, it’s a start, and that’s a lot more data than we’ve had before. Hopefully, our data will motivate others to conduct similar studies.”

He added, “This is the largest study conducted to date on this topic, and it is difficult to obtain such data as there are not many individuals who have undergone this surgery and do endurance exercises like the Iron Man Challenges.”

He concluded, “Exercise is critical to well-being.” “It is reassuring and beneficial for many patients who have had bicuspid aortic valve aneurysm surgery to be able to feel confident in their ability to participate in endurance exercises and that this is not associated with aneurysm events.”

The authors have disclosed no relevant financial relationships.

Gamma Cardiol. Posted online June 8. full text

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