Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection

Abstract

Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 ± 12.7 years old; 54.8% hypertensive) started CR 26.2 ± 17.3 days after surgery. During 30.4 ±11.6 days, they underwent 14.5 ± 4.7 sessions of endurance cycling training, and 11.8 ± 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 ± 10.2 watts and 1.2 ± 0.6 METs, respectively. The maximal BP reached during endurance training was 143 ± 14/88 ± 14 mmHg. The heart rate (HR) reserve improved from 20.2 ± 13.9 bpm to 33.2 ± 16.8 bpm while the resting HR decreased from 86.1 ± 17.4 bpm to 76.4 ± 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training.

Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial

“…in-bed cycling); however, the systolic blood pressure remained below 160 mmHg, and no serious adverse events related to exercise were observed. These findings are consistent with those reported by Zhou et al 6 Regular exercise reduces the resting blood pressure of patients. 8 Exercise results in modification of blood flow, luminal shear stress, arterial pressure, and tangential wall stress, all of which are factors that can induce changes in arterial function, diameter, and wall thickness.…”

“…women). 6 We compared the changes in blood pressure in the intervention group with that in the control group. Only a few patients experienced transient hypertension during the postural changes (e.g.…”

“…Hence, it has been difficult to adequately assess the impact of mobilization in this population. 6 Although the guidelines suggest that patients should undergo low dynamic stress exercises as soon as possible after surgery, 7 the current interventions are mainly initiated more than 4 weeks after the procedure, 6,8,9 without specifically discussing whether early mobilization can be carried out 48 hours after surgery. It is unclear which regimens of early mobilization, including specific types and intensities are safe and beneficial for patients with acute type A aortic dissection.…”

Improved Maximal Workload and Systolic Blood Pressure After Cardiac Rehabilitation Following Thoracic Aortic Repair

“…After screening by title and abstract, 18 records were eligible for full-text assessment. Five studies remained available for qualitative synthesis after assessment of the eligibility criteria 23–27. The study by Zhou et al27 was identified by forward citation searching (ie, identified through other sources).…”

“…Ten patients participated in exercise-based CR and completed the exercise test, three of whom had Marfan syndrome. Tabet et al26 included data from 54 patients with surgically treated aortic root aneurysm or ascending aorta aneurysm with a mean age of 50 ± 13 yr. Zhou et al27 included data from 75 patients with surgically treated type A aortic dissection with a mean age of 62 ± 13 yr.…”