Prehabilitation in Cardiovascular Surgery: Concepts, Evidence, and Future Direction.

Area of Science:

• Cardiology
• Geriatrics
• Perioperative Medicine

Background:

• Older, multimorbid patients undergoing cardiovascular surgery often present with frailty, sarcopenia, malnutrition, and psychological vulnerability.
• These factors are linked to poor postoperative outcomes but are not fully addressed by traditional risk assessments.
• Prehabilitation offers a proactive approach to mitigate these modifiable risks before surgery.

Purpose of the Study:

• To review current evidence on prehabilitation strategies in adult cardiovascular surgery.
• To examine the components, benefits, feasibility, and implementation barriers of prehabilitation.
• To synthesize findings to inform future research and clinical practice.

Main Methods:

• This study is a narrative review of contemporary evidence.
• It synthesizes research on prehabilitation's core components, clinical benefits, feasibility, and barriers.
• Focus is on adult cardiovascular surgery patients.

Main Results:

• Exercise-based prehabilitation, including aerobic and inspiratory muscle training, is safe and feasible.
• It improves preoperative functional capacity and consistently reduces postoperative pulmonary complications and hospital length of stay.
• Other components like nutritional optimization and psychological support show promise but are underrepresented in trials.

Conclusions:

• Prehabilitation is a promising patient-centered strategy for improving recovery and resilience in cardiovascular surgery.
• Further research with standardized designs and adequately powered trials is needed.
• Integrating prehabilitation into perioperative pathways and utilizing scalable models like tele-prehabilitation are crucial for wider adoption.