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Exercise performance in children and adolescents after the Ross procedure

Published online by Cambridge University Press:  03 February 2006

Bradley S. Marino ,
Sara K. Pasquali ,
Gil Wernovsky ,
John R. Bockoven ,
Michael McBride ,
Catherine J. Cho ,
Thomas L. Spray  and
Stephen M. Paridon
Bradley S. Marino
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
Sara K. Pasquali
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
Gil Wernovsky
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
John R. Bockoven
Affiliation:
Children's Hospital Medical Center of Akron, Akron, Ohio, United States of America
Michael McBride
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
Catherine J. Cho
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
Thomas L. Spray
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
Stephen M. Paridon
Affiliation:
Divisions of Cardiology and Cardiothoracic Surgery, at the Cardiac Center of The Children's Hospital of Philadelphia, and the Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Akron, Ohio, United States of America
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Abstract

Objectives: The Ross procedure is increasingly utilized in the treatment of aortic valvar disease in children and adolescents. Our purpose was to compare pre- and post-operative exercise state in this population. Methods: We included patients who underwent the Ross procedure at our institution between January, 1995, and December, 2003, and in whom we had performed pre- and post-operative exercise stress tests. We used a ramp bicycle protocol to measure consumption of oxygen and production of carbon dioxide. Cardiac output was estimated from effective pulmonary blood flow by the helium acetylene re-breathing technique. Results: We studied 26 patients, having a median age at surgery of 15.7 years, with a range from 7.5 to 24.1 years. The primary indication for surgery in two-thirds was combined aortic stenosis and insufficiency. Median time from the operation to the post-operative exercise stress test was 17.4 months, with a range from 6.7 to 30.2 months. There was a trend toward lower maximal consumption of oxygen after the procedure, at 36.3 plus or minus 7.6 millilitres per kilogram per minute (83.9% predicted) as opposed to 38.6 plus or minus 8.4 millilitres per kilogram per minute (88.5% predicted, p equal to 0.06). Patients after the procedure, however, had significantly increased adiposity, so that there was no difference in maximal consumption of oxygen indexed to ideal body weight before and after the operation. In 20 of the patients, aerobic capacity improved or was stable after the operation. There was no post-operative chronotropic impairment. Conclusions: In the majority of patients following the Ross procedure, exercise performance is stable and within the normal range of a healthy age and sex matched population, despite sedentary lifestyles and increased adiposity.

Keywords

Congenital cardiac malformationsaortic valve diseasecardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 1 , January 2006 , pp. 40 - 47
Copyright
© 2006 Cambridge University Press

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