Cor Vasa 2007, 49(11):397-403 | DOI: 10.33678/cor.2007.141
Our experience with rehabilitation of patients undergoing surgery for heart valve disease
- 1 Interní kardiologická klinika, Fakultní nemocnice Brno-Bohunice
- 2 Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika
Aim of study:
To assess the effect of an eight-week comprehensive rehabilitation program on basic circulatory parameters, left ventricular (LV) function, and functional capacity of patients after surgery for aortic and mitral valve disease.
Patients:
To date, a total of 22 patients (19 males and 3 females), with a mean age of 27-86 years (56 ± 16) have attended the rehabilitation program. Of this number, 16 had surgery for aortic stenosis, 4 for combined aortic valve disease, and 2 for mitral regurgitation. Overall, the surgical procedures included aortic valve replacement by a mechanical prosthesis in 15 patients, by a biological prosthesis in 5, and mitral valvuloplasty in 2. Six patients with aortic valve disease had concomitant myocardial revascularization using coronary artery bypass grafting (CABG). Pharmacotherapy included the use of antiplatelet drugs in most patients and standard therapy in line with current guidelines. The rehabilitation program was started 4-8 weeks following discharge from hospital.
Methods:
Before entering the rehabilitation program, the patients had physical examination, dynamic stress echocardiography and spiroergometry up to peak tolerable exercise. The parameters assessed include artificial valve function, LV status, and degree of compensation. Initial training intensity was determined on the basis of results of exercise testing. This was followed by aerobic training sessions at 50-80% of aerobic maximum for 30-60 minutes three times a week. Beginning with week 4, resistance exercise was being gradually added - power training of limbs of up to 50% of 1 RM (one repeated maximum) at 30-second intervals followed by a pause. Exercise testing was undertaken again upon completion of the rehabilitation program.
Results:
No significant differences between resting heart rate (HR), systolic blood pressure (SBP) or diastolic blood pressure (DBP) were seen in patients before and after the rehabilitation program (HR 77 ± 12 and 75 ± 8 bpm; SBP 127 ± 13 and 128 ± 11, and DBP 80 ± 8 and 82 ± 2 mmHg, respectively; NS). Systolic LV function (ejection fraction, EF 57.9 ± 9 pre-rehab vs. 61.0 ± 4 post-rehab) did not change while the values of diastolic and global function changed only non-significantly (transmitral flow velocity ratio, E/A, 0.99 ± 0.37 pre-rehab vs. 112 ± 0.37 post-rehab, isovolumic relaxation time, IRT, 104 ± 9 ms pre-rehab vs. 105 ± 10 post-rehab, and myocardial performace index, MPI, 0.64 ± 0.10 pre-rehab vs. 0.58 ± 0.12 post-rehab). Exercise tolerance improved significantly, from 1.39 W/kg pre-rehab to 1.72 W/kg post-rehab (p < 0.005), as did peak oxygen consumption (pVO2), from 23.07 ml/kg/min pre-rehab to 27.09 ml/kg/min post-rehab (borderline significance).
Conclusion:
Regular training of patients undergoing surgery for heart valve disease results in improved aerobic capacity and exercise tolerance the way it is in patients with coronary heart disease. While systolic LV function was not affected in our patients, there was a tendency toward improvement of parameters of diastolic filling and global LV function. Exercise of this type did not entail an undesirable circulatory response and can be recommended as part of management of patients after surgery for heart valve disease. Professional surveillance in the early postoperative period allows for proper guidance of antiplatelet therapy.
Keywords: Heart valve disease; Comprehensive rehabilitation; Exercise tolerance; Lifestyle modifications
Published: November 1, 2007 Show citation
