The programme of managed ambulatory rehabilitation for patients after heart valve defect surgery

Česká verzia

Authors: S. Nehyba ¹; V. Chaloupka ¹; R. Souček ¹; Š. Chaloupková ²; R. Vysoký ²; F. Štětka ³; E. Skřičková ³
Authors place of work: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jindřich Špinar, CSc., FESC ¹; Rehabilitační oddělení FN Brno, pracoviště Bohunice, přednostka prim. MU Dr. Jana Roubalová ²; Centrum kardiovaskulární a transplantační chirurgie Brno, ředitel doc. MU Dr. Petr Němec, CSc. ³
Published in the journal: Vnitř Lék 2009; 55(12): 1118-1125
Category: Original Contributions

Summary

The aim of our research was to evaluate the impact of 8‑week comprehensive rehabilitation programme on circulatory parameters, left ventricular (LV) function and functional capacity of patients after aortal (ao) and mitral (mi) heart defect surgery. Patient sample and methodology: The rehabilitation programme was completed by 54 patients (exercising, RHB+) following valve defect surgery (13 women/ 41 men), aged 27– 83 (56 ± 16) years. The majority were patients with aortal (ao) stenosis (39), the remainder had a combined ao defect (7), ao regurgitation (3) or mitral (mi) regurgitation (5). Myocardial revascularisation was concomitantly performed in 18 patients. There were 18 patients in the control group (non‑exercising, RHB– ). Patients from both groups were assessed before and after the rehabilitation with exercise echocardiography and spiroergometry to the individual maximum. The intervention group underwent the managed rehabilitation programme. The control group exercised individually. Results: Reduction of the heart rate (HR) values at rest and on exercise and of the systolic and diastolic blood pressure (sBP, dBP) was observed in the exercising group. However, these changes were not statistically significant. The systolic, diastolic and global LV function parameters showed improvement although, once again, not statistically significant. Highly significant improvement in exercise tolerance (1.41 W/ kg before and 1.67 W/ kg after, p < 0.01) and peak oxygen consumption (20.0 ml/ min/ kg before and 23.6 ml/ min/ kg after, p < 0.01) were observed in the exercising patients. Improvement in functional and aerobic capacity in the control group was not statistically significant. The resting and exercise parameters (SF, sBP, dBP) have not changed either. Conclusion: The ambulatory rehabilitation programme was associated with improvement in circulatory response to exercise together with reduction in resting and exercise SF, sBP a dBP values. Tendency towards improvement in systolic, diastolic and global LV function parameters was observed even though not statistically significant in our sample. Unlike control group, the exercising group showed significant increase in exercise tolerance and aerobic capacity (p < 0.01). Managed rehabilitation programme enabled evaluation of the outcomes of the surgery, better education of the patients and optimal adjustment of pharmacotherapy, the anticoagulation treatment in particular. We did not observe any adverse reactions or other complications associated with the exercise.

Key words:
valve defects – exercise tolerance – aerobic capacity – left ventricular function – lifestyle changes

Zdroje

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