ANALYSIS OF THE LONG-TERM EFFICACY AND SAFETY OF AN EARLY INPATIENT AND OUTPATIENT DISTANCE PHYSICAL REHABILITATION PROGRAM FOR PATIENTS AFTER SURGICAL CORRECTION OF ACQUIRED VALVULAR HEART DISEASE

Highlights

• To date, there is no single principle for postoperative physical rehabilitation of patients who have undergone surgical correction of acquired valvular heart disease.
• Patients participating in our comprehensive postoperative rehabilitation program, which included treadmill physical training during the early inpatient stage and outpatient training using remote rehabilitation technologies, were characterized by a higher level of exercise tolerance, lower NT-proBNP levels, higher adherence to physical training during the year after surgery compared to patients undergoing a standard postoperative rehabilitation program (dosed walking and therapeutic exercises).
• The obtained data actualize the necessity of using physical rehabilitation in patients with VHD at the early inpatient stage as a safe and effective tool for improving surgical outcomes. The use of remote rehabilitation technologies with monitoring of cardiac parameters and physical activity is a safe, effective and comfortable method of outpatient rehabilitation for patients with VHD.

Aim. To evaluate the efficacy and safety of a comprehensive postoperative rehabilitation program that includes physical training during the first inpatient period and outpatient rehabilitation using remote technologies one year after correction of acquired valvular heart disease (VHD).

Methods. The study included 40 patients who underwent successful cardiac surgical correction of acquired VHD with cardiopulmonary bypass. Exercise testing (CPET) was performed one week after intervention while patient received stable standard therapy of heart failure during uncomplicated postoperative period. Two groups of patients were formed: 1) control group with standard postoperative rehabilitation including measures of physical rehabilitation, such as gymnastics and graded walking (n = 23). 2) main group with standard postoperative rehabilitation (graded walking, gymnastics) and early physical training with daily treadmill walking starting from the 8th day after surgery lasting 14 days (n = 17). In main group the physical rehabilitation was continued on outpatient period using remote technologies. During the outpatient phase, patients were recommended to work with a mobile application for four months according to individually selected programs of physical rehabilitation. Safety of training was controlled by assessing cardiovascular system response to physical load using fitness bracelet during the daytime and self-performed six-channel electrocardiography (ECG) using ECG dongle before and after training at home. At the time of installation of the application until discharge from hospital, also as in dynamics 4 months and 1 year after, standard clinical-instrumental examination, CPET, transthoracic echocardiography, and assessment of serum levels of myocardial strain markers (NT-proBNP, sST2) were conducted.

Results: Patients participating in the developed complex rehabilitation program involving treadmill training during the inpatient stage and outpatient training using remote technologies demonstrated higher tolerance to physical activity, lower values of NT-proBNP level, and greater adherence to physical exercises over the one year compared to those undergoing standard postoperative rehabilitation.

Conclusion. The obtained data highlight the necessity of applying physical rehabilitation in patients with VHD at the early inpatient stage as a safe and effective tool for improving surgical outcomes. Using remote rehabilitation technologies with monitoring of cardiac function parameters and physical activity is a safe, efficient, and comfortable method for outpatient rehabilitation in pts with VHD.

1. Visseren F.L.J., Mach F., Smulders Y.M. et al.; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–3337. DOI: 10.1093/eurheartj/ehab484

2. Bokeriya L.A., Aronov D.M. Russian clinical guidelines. Coronary artery bypass grafting in patients with is- chemic heart disease: rehabilitation and secondary prevention. Cardiosomatics. 2016;7(3–4):5–71 (in Russ).

3. Sarana A.M., Kamilova T.A., Lebedeva S.V. et al. Cardiac Rehabilitation. Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):24–39 (in Russ)]. DOI: 10.36425/rehab64287.

4. Mamataz T., Uddin J., Ibn Alam S. et al.; ACROSS collaboration. Effects of cardiac rehabilitation in low-and middle-income countries: A systematic review and meta-analysis of randomised controlled trials. Prog Cardiovasc Dis. 2022;70:119–174. DOI: 10.1016/j.pcad.2021.07.004.

5. Taylor R.S., Fredericks S., Jones I. et al. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2023;44(28):2515–2525. DOI: 10.1093/eurheartj/ehad225.

6. Grace S.L., Kotseva K., Whooley M.A. Cardiac Rehabilitation: Under-Utilized Globally. Curr Cardiol Rep. 2021;23(9):118. DOI: 10.1007/s11886-021-01543-x.

7. Turk-Adawi K., Ghisi G.L.M., Tran C. et al.; ICRR collaborators. First report of the International Council of Cardiovascular Prevention and Rehabilitation's Registry (ICRR). Expert Rev Cardiovasc Ther. 2023;21(5):357–364. DOI: 10.1080/14779072.2023.2199154.

8. Bubnova M.G. Relevant problems of participation and education of patients in cardiac rehabilitation and secondary prevention programs. Cardiovascular Therapy and Prevention. 2020;19(6):2649 (in Russ.)]. DOI: 10.15829/1728-8800-2020-2649

9. Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, Marsan NA, Barili F, Bonaros N, Cosyns B, De Paulis R, Gamra H, Jahangiri M, Jeppsson A, Klautz RJM, Mores B, Pérez-David E, Pöss J, Prendergast BD, Rocca B, Rossello X, Suzuki M, Thiele H, Tribouilloy CM, Wojakowski W; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2025 ;67(8):ezaf276. doi: 10.1093/ejcts/ezaf276

10. Taran I.N., Pomeshkina S.A., Argunova Yu.A. et al. Aerobic exercises are safe and effective in early rehabilitation following cardiac surgery. Complex Issues of Cardiovascular Diseases. 2020;9 (3):30–39 (in Russ)]. DOI: 10.17802/2306-1278-2020-9-3-30-39.

11. Lyapina I.N., Argunova Yu.A., Dren E.V.', et al. Effectiveness of early rehabilitation program with remote technologies in the outpatient setting after surgery for acquired valvular heart disease. Russian Medical Inquiry. 2024;8(1):16–25 (in Russ.). DOI: 10.32364/2587-6821-2024-8-1-3.

12. Inozemtseva AA, Argunova YuA, Pomeshkina SA, et al. Efficiency and safety of early physical trainings during rehabilitation of patients after coronary bypass grafting.Siberian Medical Review.2018;(6):33-42. DOI: 10.20333/2500136-2018-6-33-42.

13. Gorbunova E.V., Rozhnev V.V., Lyapina I.N., Barbarash O.L. Dynamics of adherence to treatment and quality of life in patients with prosthetic heart valves who participated in the educational programs (10-year follow-up). Complex Issues of Cardiovascular Diseases. 2022;11(1):69-77. (In Russ.) https://doi.org/10.17802/2306-1278-2022-11-1-69-77

14. Lyapina IN, Solodukhin AV, Shaleva VA, et al. Adherence to remote rehabilitation program after on-pump cardiac surgey in pandemic period. Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(2):183 189. (In Russ.) https://doi.org/10.17116/kardio202316021183

15. Remote rehabilitation of patients who have undergone heart surgery. Zvereva T.N., Barbarash O.L., Vidyaeva N.G., et al. Certificate of registration of the computer program 2020617994, 15.07.2020. Application No. 2020617074 dated 06.07.2020. (In Russ)

16. Pelliccia A, Sharma S, Gati S, et al. ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021;42(1):17-96. doi: 10.1093/eurheartj/ehaa605.

17. Cieza A., Causey K., Kamenov K. et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021;396(10267):2006-2017. DOI: 10.1016/S0140-6736(20)32340-0.

18. Ochiai K, Kameda I, Kato Y, et al. Impact of Delayed Postoperative Rehabilitation on Patients with Valvular Heart Disease: A Retrospective Cohort Study. Prog Rehabil Med. 2025;10:20250006. doi: 10.2490/prm.20250006.

19. Zvereva T.N., Samus I.V., Pronina A.A., et al. Long-term results of outpatient rehabilitation after coronary artery bypass graft surgery. Fundamental and Clinical Medicine. 2024;9(3):57-65. (In Russ.)

20. Аvila A., Claes J., Buys R. et al. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? Eur J Prev Cardiol. 2020;27(4):367–377. DOI: 10.1177/2047487319892201.

21. Laustsen S, Oestergaard LG, van Tulder M. Telemonitored exercise-based cardiac rehabilitation improves physical capacity and health-related quality of life. J Telemed Telecare. 2020;26(1-2):36-44. DOI: 10.1177/1357633X18792808.

22. Song Y, Ren C, Liu P. Effect of Smartphone-Based Telemonitored Exercise Rehabilitation among Patients with Coronary Heart Disease. Cardiovasc Transl Res. 2020;13(4):659–667. DOI: 10.1007/s12265-019-09938-6.

23. Pomeshkina S.A., Loktionova E.B., Kasparov E.V., et al Comparative analysis of efficiency of supervised and home-based physical trainings in the outpatient cardiac rehabilitation program in patients after coronary artery bypass grafting. Complex Issues of Cardiovascular Diseases. 2017;(2):40–49 (in Russ.)]. DOI: 10.17802/2306-1278-2017-2-40-49.

24.