Optimal timing of rehabilitation after cardiac surgery: the surgeon's view

Abstract

Cardiac rehabilitation has become an accepted adjunct treatment for the majority of patients with cardiovascular disease, especially for those who have received cardiac surgery. However, improved survival has not been generally demonstrated in a supervised cardiac rehabilitation programme, while some benefits have been found in functional capacity, psychosocial characteristics and lipoprotein patterns of patients who underwent sustained periods of exercise training. The influence of post-surgical conditions on phase II rehabilitation following cardiac surgery has not yet been well addressed. Many factors may influence the timing of phase II rehabilitation following cardiac surgery, especially the pre-operative condition of the patient, the concomitant morbidity, the incidence of peri-operative complications and the rapidity of recovery, mainly influenced by post-operative cardiac and lung function, pain and wound healing. This article reviews the general and specific medical and surgical problems encountered during early follow-up of cardiac surgery patients, which might affect the timing of postoperative rehabilitation, analyses briefly the impacts of less invasive heart surgery on cardiac rehabilitation as well as that of fast tract protocols after conventional heart surgery. Some patients required service intervention during cardiac rehabilitation while others were withdrawn from cardiac rehabilitation for medical reasons or surgery-related complications. Specific problems in patients following cardiac transplantation are depicted briefly. Cardiac transplant recipients may suffer from pre-operative end-stage heart failure, prolonged cold ischaemia of the donor heart, denervation of the cardiac allograft, immunological allomismatch, and unusual psychological stress. In summary, phase II cardiac rehabilitation on a stationary and more recently on an ambulatory basis is generally recommended two to four weeks following uncomplicated coronary and valvular procedures, while patients following cardiac transplantation may be included in such programmes after approximately four to six weeks. The earliest rehabilitation is possible in patients following less invasive heart surgery and may start one to two weeks postoperatively.