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Cochrane corner: Exercise-based cardiac rehabilitation for adults after heart valve surgery
  1. Kirstine Lærum Sibilitz1,
  2. Lizette Anayo2,
  3. Rod S Taylor3
  1. 1 Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  2. 2 Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  3. 3 MRC/CSO Social and Public Health, Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
  1. Correspondence to Kirstine Lærum Sibilitz, Department of Cardiology, Copenhagen University Hospital, 2100 Copenhagen, Rigshospitalet Copenhagen - Copenhagen University Hospital, Denmark; Kirstine.Laerum.Sibilitz.01{at}regionh.dk

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Background

Heart valve disease accounts for one‐third of all heart diseases and the prevalence is increasing due to an ageing population, population growth and advances in treatment methods.1 Heart valve diseases are mostly degenerative in nature and treatment of advanced heart valve disease includes surgery, either percutaneous or surgical valve replacement or repair.

The changing disease pattern and expected increase in healthcare burden, and the large number of acute hospitalisations after valve surgery require a well‐established after‐care including cardiac rehabilitation. Issues after valve surgery also include physical and psychological issues. Physical inactivity is a problem for heart valve surgery patients, who may experience presurgical dyspnoea and physical incapacity, immobilisation during hospitalisation, and potential postsurgical complications and restrictions due to healing of the sternum. Open heart surgery is a stressful life event and health-related quality of life (HRQoL) is likely to be negatively affected, along with mental health; patients may require support for depressive symptoms and anxiety. Although such problems may also occur after percutaneous procedures, recent studies suggest that after transcatheter aortic valve replacement (TAVR), patients have much better HRQoL within 2 weeks of the procedure.

Several attempts have been investigated to emphasise these issues and both European Society of Cardiology/European Association for Cardio‐Thoracic Surgery (ESC/EACTS) guidelines suggest cardiac rehabilitation after heart valve surgery.2 3 One trial has shown that individualised follow‐up programmes reduce readmissions after heart valve surgery. A meta‐analysis published in 2017 including six trials showed that participation in exercise training after TAVR can increase exercise capacity within the first year after the procedure.4 This is supported by a systematic review and meta‐analysis published in 2019 reporting that exercise‐based cardiac rehabilitation (CR) improves exercise capacity of post‐TAVR and post‐surgical aortic valve replacement (SAVR) patients in the short term.5

Current European guidelines recommend that rehabilitation after heart …

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Footnotes

  • Contributors All authors take public responsibility for the content of the work submitted for review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews

    2021, Issue May 7;5(5). 10.1002/14651858.CD010876.pub3 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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