The value of cardiopulmonary exercise testing in cardiovascular rehabilitation

after aortic valve replacement

Background:
Since the 1950s when the stair climb test was implemented for surgical patients, the
exercise-testing evolved more and more until nowadays when the cardiopulmonary exercise
test (CPET) became available to a limited number of hospitals. In this context, the aim of this
paper is to focus on the benefits the CPET brings on tailoring an individualized exercise
routine in patients who underwent surgery for aortic valve replacement.
Case presentation:
We present the case of a 65 years old male patient who is admitted to the Cardiology
department for the classic triad of dyspnea, syncope and chest pain. Echocardiography was
performed and the diagnosis of aortic stenosis with severe obstruction was established. The
aortic valve was replaced with a mechanic one through surgery. Subsequently, the patient
was included in a cardiovascular rehabilitation programme and it was necessary to
determine which is the maximum effort level our patient is capable of. Here comes the role of
CPET in customizing an efficient aerobic exercise routine in order to obtain a significant
adaptation in cardiopulmonary function. Currently, three years after surgery, our patient was
reevaluated through CPET and the result consists of a significantly increased peakVO2, in
accordance with the clinical improvement and the enhancement of the echocardiographic
parameters.
Conclusions:
The management of the patients who underwent heart valve replacement surgeries is
complex and require a multidisciplinary team. The peculiarity of the case consists of the fact
that our patient benefitted from a customized programme of aerobic exercise to promote the
improvement of his cardiopulmonary functionality, which would not have been possible
without the aid of CPET, the golden standard in exercise testing.