Peri-operative rehabilitation in patients undergoing elective cardiac valve surgery: a randomised controlled trial

Patients with valvular heart disease are at high risk of postoperative pulmonary complications, which contribute to morbidity and mortality. However, few studies have focused specifically on peri-operative rehabilitation in this patient population. We aimed to evaluate whether peri-operative rehabilitation benefits patients undergoing elective cardiac valve surgery by reducing the incidence of postoperative pulmonary complications, the duration of postoperative hospitalisation and mortality.

This single-centre, randomised controlled trial compared usual care (usual care group) with a peri-operative rehabilitation bundle (rehabilitation group) comprising four components: education; inspiratory muscle training; active cycle of breathing techniques; and early mobilisation. The primary outcome was a composite measure of the occurrence of postoperative pulmonary complications within the first 7 days; incidence of prolonged postoperative hospitalisation > 7 days; and in-hospital all-cause mortality. Secondary outcomes included each component of primary outcome measure; duration of stay in the ICU; total duration of postoperative hospitalisation; and 3-month all-cause mortality.

On an intention-to-treat basis, data from 818 patients were analysed (419 allocated to the usual care group and 399 to the rehabilitation group). The primary composite outcome did not differ between groups, occurring in 224/419 (53.5%) patients allocated to the usual care group and 206/399 (51.6%) patients allocated to the rehabilitation group (odds ratio 0.88, 95%CI 0.66-1.17, p = 0.376). Postoperative pulmonary complications were present in 197 (47.1%) patients allocated to the usual care group and 161 (40.4%) patients allocated to the rehabilitation group (odds ratio 0.720, 95%CI 0.541-0.956, p = 0.023). There was no significant difference between the groups in terms of duration of postoperative hospital stay of > 7 days or in-hospital mortality.

Peri-operative rehabilitation reduced the incidence of postoperative pulmonary complications in patients having surgery for valvular heart disease. We recommend incorporating comprehensive peri-operative rehabilitation into the clinical management of these patients.