Rehabilitation of patients after cardiac surgery

Background. Patients undergoing cardiac surgery are under a high risk of post-operative reductions in respiratory muscle strength and pulmonary function as well as lowered functional capacity. In-hospital physical inactivity and inappropriate rehabilitation increases the chances for development of these complications and affects patients’ future independence in daily routine. Cardiac rehabilitation is crucial in preventing complications and assisting the early function recovery. However, despite the evidences for its benefits and strong guideline recommendations, the uptake of cardiac rehabilitation remains poor. Objective. this study is aimed at promotion of cardiac rehabilitation and sharing successful experience of using it. Methods. Post-surgical treatment and rehabilitation of 387 patients with cardiovascular pathology in the Department of Vascular and Cardiac Surgery of Municipal Non-Commercial Enterprise “Ternopil Regional Clinical Hospital” of Ternopil Regional Council has been analysed. Results. The experience of successful post-surgical treatment and rehabilitation allowed establishing the basic approaches to perioperative management of patients with cardiovascular surgical pathology. Key principles include minimized ICU stay and artificial ventilation time, early verticalization and beginning of physical activities, early removed drainage tubes, tracheobronchial tree drainage, nutritional balance, lymphatic drainage massage, application of elastic jersey on the lower extremities, early transferring to the surgery ward and returning to the regular daily activities, circumstantial health education, complex work of a multidisciplinary team. Conclusions. This set of rehabilitation measures helps prevent complications after cardiac surgery as well as provide a faster patient’s daily routine

cardiac surgery, cardiac rehabilitation, exercise, recovery of function, health education

https://doi.org/10.11603/ijmmr.2413-6077.2021.2.12556

[1] Hartog J, Blokzijl F, Dijkstra S, DeJongste M, Reneman M, Dieperink W et al. Heart Rehabilitation in patients awaiting Open heart surgery targeting to prevent Complications and to improve Quality of life (Heart-ROCQ): study protocol for a prospective, randomised, open, blinded endpoint (PROBE) trial. BMJ Open. 2019;9(9):e031738. https://doi.org/10.1136/bmjopen-2019-031738

[2] Westerdahl E, Lindmark B, Bryngelsson I, Tenling A. Pulmonary function 4 months after coronary artery bypass graft surgery. Respiratory Medicine. 2003;97(4):317-322. https://doi.org/10.1053/rmed.2002.1424

[3] Kristjánsdóttir Á, Ragnarsdóttir M, Hannes­son P, Beck H, Torfason B. Respiratory movements are altered three months and one year following cardiac surgery. Scandinavian Cardiovascular Journal. 2004;38(2):98-103. https://doi.org/10.1080/14017430410028492

[4] Koster S, Hensens A, Schuurmans M, van der Palen J. Consequences of Delirium After Cardiac Operations. The Annals of Thoracic Surgery. 2012;93(3):705-711. https://doi.org/10.1016/j.athoracsur.2011. 07.006

[5] Iribarne A, Chang H, Alexander J, Gillinov A, Moquete E, Puskas J et al. Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. The Annals of Thoracic Surgery. 2014;98(4):1274-1280. https://doi.org/10.1016/j.athoracsur.2014. 06.059

[6] Kosuma P, Wachirasrisirikul S, Jedsadayan­mata A. Attributable Costs of Postoperative Atrial Fibrillation among Patients Undergoing Cardiac Surgery. Cardiology Research and Practice. 2018;2018:1-5. https://doi.org/10.1155/2018/3759238

[7] van der Peijl I, Vliet Vlieland T, Versteegh M, Lok J, Munneke M, Dion R. Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program. The Annals of Thoracic Surgery. 2004;77(5):1535-1541. https://doi.org/10.1016/j.athoracsur.2003.10.091

[8] Bots M, van Dis I, Koopman C, Vaartjes I, Visseren F. Hart- en vaatziekten in Nederland, 2014, cijfers over kwaliteit van leven, ziekte en sterfte. Den Haag: Hartstichting; 2014. https://adoc.pub/queue/cijfers-over-kwaliteit-van-leven-ziekte-en-sterfte-hart-en-v.html Accessed December 2014.

[9] Kortebein P, Symons T, Ferrando A, Paddon-Jones D, Ronsen O, Protas E et al. Functional Impact of 10 Days of Bed Rest in Healthy Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2008;63(10):1076-1081. https://doi.org/10.1093/gerona/63.10.1076

[10] Convertino V, Hung J, Goldwater D, DeBusk R. Cardiovascular responses to exercise in middle-aged men after 10 days of bedrest. Circulation. 1982;65(1): 134-140. https://doi.org/10.1161/01.cir.65.1.134

[11] Westerdahl E, Lindmark B, Eriksson T, Fri­berg Ö, Hedenstierna G, Tenling A. Deep-Breathing Exercises Reduce Atelectasis and Improve Pulmonary Function After Coronary Artery Bypass Surgery. Chest. 2005;128(5):3482-3488. https://doi.org/10.1378/chest.128.5.3482

[12] Richardson C, Franklin B, Moy M, Jackson E. Advances in rehabilitation for chronic diseases: improving health outcomes and function. BMJ. 2019;l2191. https://doi.org/10.1136/bmj.l2191

[13] Ambrosetti M, Abreu A, Corrà U, Davos C, Hansen D, Frederix I et al. Secondary prevention through comprehensive cardiovascular rehabi­litation: From knowledge to implementation. 2020 update. A position paper from the Secondary Pre­vention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology. 2020;28(5):460-495. https://doi.org/10.1177/2047487320913379

[14] Taylor R, Dalal H, McDonagh S. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology. 2021. https://doi.org/10.1038/s41569-021-00611-7

[15] Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesse­link JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M; ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021:1;42(1):17-96. https://doi.org/10.1093/eurheartj/ehaa605

[16] Abraham LN, Sibilitz KL, Berg SK, Tang LH, Risom SS, Lindschou J, Taylor RS, Borregaard B, Zwisler A-D. Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database of Systematic Reviews. 2021:5. Art. No.: CD010876. https://doi.org/10.1002/14651858.CD010876.pub3.