{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:25:19Z","timestamp":1784366719811,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T00:00:00Z","timestamp":1649462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions\/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 \u00b1 12.7 years old; 54.8% hypertensive) started CR 26.2 \u00b1 17.3 days after surgery. During 30.4 \u00b111.6 days, they underwent 14.5 \u00b1 4.7 sessions of endurance cycling training, and 11.8 \u00b1 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 \u00b1 10.2 watts and 1.2 \u00b1 0.6 METs, respectively. The maximal BP reached during endurance training was 143 \u00b1 14\/88 \u00b1 14 mmHg. The heart rate (HR) reserve improved from 20.2 \u00b1 13.9 bpm to 33.2 \u00b1 16.8 bpm while the resting HR decreased from 86.1 \u00b1 17.4 bpm to 76.4 \u00b1 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training.<\/jats:p>","DOI":"10.3390\/jcm11082107","type":"journal-article","created":{"date-parts":[[2022,4,10]],"date-time":"2022-04-10T06:02:54Z","timestamp":1649570574000},"page":"2107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6237-541X","authenticated-orcid":false,"given":"Na","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Fortin","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Balice","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oksana","family":"Kovalska","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Cristofini","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Ledru","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-932X","authenticated-orcid":false,"given":"Warner M.","family":"Mampuya","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1913-0780","authenticated-orcid":false,"given":"Marie-Christine","family":"Iliou","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/HCR.0000000000000521","article-title":"Aortic Aneurysm: Diagnosis, Management, Exercise Testing, and Training","volume":"40","author":"Ehrman","year":"2020","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jama.283.7.897","article-title":"The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease","volume":"283","author":"Hagan","year":"2000","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"192459","DOI":"10.1155\/2013\/192459","article-title":"Aortic Dissection Type A in Alpine Skiers","volume":"2013","author":"Schachner","year":"2013","journal-title":"BioMed Res. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.jtcvs.2005.02.052","article-title":"Mechanical deterioration underlies malignant behavior of aneurysmal human ascending aorta","volume":"130","author":"Koullias","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1152\/physrev.00014.2016","article-title":"Vascular Adaptation to Exercise in Humans: Role of Hemodynamic Stimuli","volume":"97","author":"Green","year":"2017","journal-title":"Physiol. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1080\/14017431.2016.1257149","article-title":"Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients","volume":"51","author":"Fuglsang","year":"2017","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ijcard.2016.06.026","article-title":"Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities","volume":"219","author":"Delsart","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/clc.22418","article-title":"Survivors of Aortic Dissection: Activity, Mental Health, and Sexual Function","volume":"38","author":"Chaddha","year":"2015","journal-title":"Clin. Cardiol."},{"key":"ref_10","first-page":"293","article-title":"Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress","volume":"5","author":"Ku","year":"1985","journal-title":"Arter. Off. J. Am. Heart Assoc. Inc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12938-016-0273-z","article-title":"A multi-component parallel-plate flow chamber system for studying the effect of exercise-induced wall shear stress on endothelial cells","volume":"15","author":"Wang","year":"2016","journal-title":"Biomed. Eng. Online"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1161\/01.CIR.0000109141.48980.37","article-title":"Physical training increases endothelial progenitor cells, inhibits neointima formation, and enhances angiogenesis","volume":"109","author":"Laufs","year":"2004","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1002\/clc.22481","article-title":"Exercise and Physical Activity for the Post-Aortic Dissection Patient: The Clinician\u2019s Conundrum","volume":"38","author":"Chaddha","year":"2015","journal-title":"Clin. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S387","DOI":"10.1097\/00005768-199810001-00007","article-title":"Exercise and the Marfan syndrome","volume":"30","author":"Braverman","year":"1998","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e006438","DOI":"10.1161\/JAHA.117.006438","article-title":"Cardiovascular Benefits of Moderate Exercise Training in Marfan Syndrome: Insights from an Animal Model","volume":"6","author":"Siegert","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/S0140-6736(14)61005-9","article-title":"Management of acute aortic dissection","volume":"385","author":"Nienaber","year":"2015","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e001513","DOI":"10.1161\/JAHA.114.001513","article-title":"Risk Profiles for Aortic Dissection and Ruptured or Surgically Treated Aneurysms: A Prospective Cohort Study","volume":"4","author":"Landenhed","year":"2015","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1177\/2047487320936782","article-title":"Beyond randomised studies: Recommendations for cardiac rehabilitation following repair of thoracic aortic aneurysm or dissection","volume":"28","author":"Schwaab","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.acvd.2012.01.010","article-title":"French Society of Cardiology guidelines for cardiac rehabilitation in adults","volume":"105","author":"Pavy","year":"2012","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.amjcard.2020.04.049","article-title":"New Equations for Predicting Maximum Oxygen Uptake in Patients with Heart Failure","volume":"128","author":"Kokkinos","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.tcm.2017.02.005","article-title":"The role of cardiac rehabilitation in patients with heart disease","volume":"27","author":"McMahon","year":"2017","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1146\/annurev-med-100415-022956","article-title":"Therapeutics Targeting Drivers of Thoracic Aortic Aneurysms and Acute Aortic Dissections: Insights from Predisposing Genes and Mouse Models","volume":"68","author":"Milewicz","year":"2017","journal-title":"Annu. Rev. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jacc.2019.12.043","article-title":"Pathogenic FBN1 Genetic Variation and Aortic Dissection in Patients with Marfan Syndrome","volume":"75","author":"Milleron","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1249\/MSS.0b013e3182a088b8","article-title":"A Randomized Trial of Exercise Training in Abdominal Aortic Aneurysm Disease","volume":"46","author":"Myers","year":"2014","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e007959","DOI":"10.1161\/JAHA.117.007959","article-title":"Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm","volume":"7","author":"Nakayama","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1038\/sj.jhh.1001377","article-title":"Potential causes, mechanisms, and implications of post exercise hypotension","volume":"16","author":"MacDonald","year":"2002","journal-title":"J. Hum. Hypertens."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/HJR.0b013e32831fd6c8","article-title":"Cardiac Rehabilitation working Group of the French Society of Cardiology French registry of cases of type I acute aortic dissection admitted to a cardiac rehabilitation center after surgery","volume":"16","author":"Corone","year":"2009","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1161\/CIRCULATIONAHA.113.005819","article-title":"Activity Recommendations for Postaortic Dissection Patients","volume":"130","author":"Chaddha","year":"2014","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.ejvs.2018.03.009","article-title":"Exercise after Aortic Dissection: To Run or Not to Run","volume":"55","author":"Spanos","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","article-title":"Exercise standards for testing and training: A scientific statement from the American Heart Association","volume":"128","author":"Fletcher","year":"2013","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/HCR.0000000000000446","article-title":"Cardiopulmonary Exercise Testing Following Open Repair for a Proximal Thoracic Aortic Aneurysm or Dissection","volume":"40","author":"Hornsby","year":"2020","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1177\/1559827608323210","article-title":"The Clinical Significance of Aerobic Exercise Testing and Prescription: From Apparently Healthy to Confirmed Cardiovascular Disease","volume":"2","author":"Arena","year":"2008","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.cger.2019.06.001","article-title":"Cardiac Rehabilitation to Optimize Medication Regimens in Heart Failure","volume":"35","author":"Goyal","year":"2019","journal-title":"Clin. Geriatr. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"62","DOI":"10.15420\/ecr.2011.7.1.62","article-title":"The Role of Cardiac Rehabilitation in Achieving Optimal Treatment","volume":"7","author":"Mendes","year":"2011","journal-title":"Eur. Cardiol."},{"key":"ref_35","first-page":"538","article-title":"Normal cardiopulmonary responses during incremental exercise in 20- to 70-yr-old men","volume":"26","author":"Inbar","year":"1994","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_36","first-page":"59","article-title":"The effects of smoking and the degree of nicotine dependence on aerobic capacity in sportsmen","volume":"21","author":"Tchissambou","year":"2004","journal-title":"Rev. Mal. Respir."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1152\/jappl.1985.58.6.1975","article-title":"Immediate effects of cigarette smoking on cardiorespiratory responses to exercise","volume":"58","author":"Hirsch","year":"1985","journal-title":"J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1249\/00005768-198025000-00003","article-title":"Smoking habits, alcohol consumption and maximal oxygen uptake","volume":"12","author":"Montoye","year":"1980","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1539\/sangyoeisei.37.6_409","article-title":"A cross-sectional analysis on relationships between maximum oxygen uptake and risk factors for cardiovascular diseases","volume":"37","author":"Tobita","year":"1995","journal-title":"Sangyo Eiseigaku Zasshi"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1123\/jpah.6.5.667","article-title":"The Effect of Habitual Smoking on Measured and Predicted VO2max","volume":"6","author":"Suminski","year":"2009","journal-title":"J. Phys. Act. Health"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/8\/2107\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:51:08Z","timestamp":1760136668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/8\/2107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,9]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11082107"],"URL":"https:\/\/doi.org\/10.3390\/jcm11082107","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,9]]}}}