PDF(Pubmed)
Abstract：
BACKGROUND: There is lack of evidence regarding safety, effectiveness and applicability of prehabilitation on cardiac surgery population, particularly in patients candidates to cardiac valve replacement. The aim of the study is to assess and compare the effect of a multimodal prehabilitation program on functional capacity in patients with severe aortic stenosis (AoS) and severe mitral regurgitation (MR) proposed for valve replacement surgery.
METHODS: Secondary analysis from a randomised controlled trial whose main objective was to analyze the efficacy of a 4-6 weeks multimodal prehabilitation program in cardiac surgery on reducing postoperative complications. For this secondary analysis, only candidates for valve replacement surgery were selected. The primary outcome was the change in endurance time (ET) from baseline to preoperative assessment measured by a cycling constant work-rate cardiopulmonary exercise test.
RESULTS: 68 patients were included in this secondary analysis, 34 (20 AoS and 14 MR) were allocated to the prehabilitation group and 34 (20 AoS and 14 MR) to control group. At baseline, patients with AoS had better left systolic ventricular function and lower prevalence of atrial fibrillation compared to MR (p = 0.022 and p = 0.035 respectively). After prehabilitation program, patients with MR showed greater improvement in ET than AoS patients (101% vs. 66% increase from baseline). No adverse events related to the prehabilitation program were observed.
CONCLUSIONS: A 4-6 week exercise training program is safe and overall improves functional capacity in patients with severe AoS and MR. However, exercise response is different according to the cardiac valve type disfunction, and further studies are needed to know the factors that predispose some patients to have better training response.
BACKGROUND: The study has been registered on the Registry of National Institutes of Health ClinicalTrials.gov (NCT03466606) (05/03/2018).
METHODS: Secondary analysis from a randomised controlled trial whose main objective was to analyze the efficacy of a 4-6 weeks multimodal prehabilitation program in cardiac surgery on reducing postoperative complications. For this secondary analysis, only candidates for valve replacement surgery were selected. The primary outcome was the change in endurance time (ET) from baseline to preoperative assessment measured by a cycling constant work-rate cardiopulmonary exercise test.
RESULTS: 68 patients were included in this secondary analysis, 34 (20 AoS and 14 MR) were allocated to the prehabilitation group and 34 (20 AoS and 14 MR) to control group. At baseline, patients with AoS had better left systolic ventricular function and lower prevalence of atrial fibrillation compared to MR (p = 0.022 and p = 0.035 respectively). After prehabilitation program, patients with MR showed greater improvement in ET than AoS patients (101% vs. 66% increase from baseline). No adverse events related to the prehabilitation program were observed.
CONCLUSIONS: A 4-6 week exercise training program is safe and overall improves functional capacity in patients with severe AoS and MR. However, exercise response is different according to the cardiac valve type disfunction, and further studies are needed to know the factors that predispose some patients to have better training response.
BACKGROUND: The study has been registered on the Registry of National Institutes of Health ClinicalTrials.gov (NCT03466606) (05/03/2018).
摘要：
背景：缺乏关于安全性的证据，康复治疗对心脏手术人群的有效性和适用性，特别是在心脏瓣膜置换术的患者中。该研究的目的是评估和比较多模式康复计划对建议用于瓣膜置换手术的重度主动脉瓣狭窄（AoS）和重度二尖瓣反流（MR）患者的功能能力的影响。
方法：次要分析来自一项随机对照试验，其主要目的是分析心脏手术中4-6周多模式康复计划对减少术后并发症的疗效。对于这个二次分析，仅选择了瓣膜置换手术的候选人.主要结果是通过循环恒定工作率心肺运动测试测量的从基线到术前评估的耐力时间（ET）的变化。
结果：68例患者被纳入本次二次分析，34（20AoS和14MR）被分配给康复治疗组，34（20AoS和14MR）被分配给对照组。在基线,与MR相比,AoS患者的左心室收缩功能更好,房颤发生率更低(分别为p=0.022和p=0.035).在康复计划之后，与AoS患者相比，MR患者的ET改善更大(101%vs.比基线增加66%)。没有观察到与康复计划相关的不良事件。
结论：4-6周的运动训练计划是安全的，并且总体上改善了患有严重AoS和MR的患者的功能能力。然而,运动反应根据心脏瓣膜功能障碍的类型而不同，需要进一步的研究来了解一些患者有更好的训练反应的因素。
背景：该研究已在美国国立卫生研究院ClinicalTrials.gov（NCT03466606）（2018年3月5日）注册。
方法：次要分析来自一项随机对照试验，其主要目的是分析心脏手术中4-6周多模式康复计划对减少术后并发症的疗效。对于这个二次分析，仅选择了瓣膜置换手术的候选人.主要结果是通过循环恒定工作率心肺运动测试测量的从基线到术前评估的耐力时间（ET）的变化。
结果：68例患者被纳入本次二次分析，34（20AoS和14MR）被分配给康复治疗组，34（20AoS和14MR）被分配给对照组。在基线,与MR相比,AoS患者的左心室收缩功能更好,房颤发生率更低(分别为p=0.022和p=0.035).在康复计划之后，与AoS患者相比，MR患者的ET改善更大(101%vs.比基线增加66%)。没有观察到与康复计划相关的不良事件。
结论：4-6周的运动训练计划是安全的，并且总体上改善了患有严重AoS和MR的患者的功能能力。然而,运动反应根据心脏瓣膜功能障碍的类型而不同，需要进一步的研究来了解一些患者有更好的训练反应的因素。
背景：该研究已在美国国立卫生研究院ClinicalTrials.gov（NCT03466606）（2018年3月5日）注册。
