CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_11(12)_628-62910.15836/ccar2016.628Extended AbstractOutpatient cardiovascular rehabilitation after aortic valve surgery: Croatian experiencehttp://orcid.org/0000-0002-3888-4804SkorićKristina Narančić1http://orcid.org/0000-0002-6426-6831IvanušaMario12http://orcid.org/0000-0001-8804-1357Dražić-BalovJadranka1http://orcid.org/0000-0001-6037-7537MuminovićŽaklina1Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, CroatiaUniversity of Rijeka School of Medicine, Rijeka, CroatiaAddress for correspondence: Mario Ivanuša, Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Draškovićeva 13, HR-10000 Zagreb, Croatia. / Phone: +385-1-4612-290; Fax: +385-1-4612-343 / E-mail: mivanusa@gmail.com112016111262862910112016201120162016Croatian Cardiac SocietyKeywords: aortic valve surgeryoutpatient cardiovascular rehabilitationCroatia
Introduction: While the benefits of the cardiovascular rehabilitation (CVR) after the myocardial surgical coronary revascularization are well documented, only a few studies have indicated the benefits of CVR in patients after the aortic valve surgery. (1, 2) The aim of the paper is to show the experience of the only Croatian center of the outpatient CVR in patients after the aortic valve surgery.
Patients and Methods: We retrospectively analyzed the data from the medical charts of all patients with operated aortic valve involved in the outpatient CVR program in the Institute for Cardiovascular Diseases Prevention and Rehabilitation in Zagreb from 10th January 2012, and who ceased to participate in the program by 6th October 2016. The performance of the CVR program in the Insitute has already been described. (3) In addition to the data on a type of intervention and risk factors, we have also analyzed the frequency of the optimally performed anticoagulant therapy (4) and changes to the functional capacity at the end of the CVR. The results were presented by groups according to gender by using the descriptive statistics methods.
Results: Out of 53 patients involved, 18 (34%) were women and 35 (66%) men. The average duration of CVR was 2.6 months. The main disease is aortic stenosis, which was present in 80% of men and 89% of women. The analysis of the frequency of the interventions performed, risk factors and the success of anticoagulant therapy is shown in Table 1. The mean functional capacity value at the beginning and end of the CVR was 5.9±1.39 and 6.8±1.17 for men and 5.6±0.85 and 6.4±1,12 METs for women.
The frequency of performed cardiac surgeries, risk factors and success of anticoagulant therapy in patients undergoing outpatient cardiovascular rehabilitation following aortic valve surgery.
Menn = 35
Womenn = 18
AllN = 53
Aortic stenosis
80.0% (28/35)
88.9% (16/18)
83.0% (44/53)
Aortic Valve Replacement Surgery
Bioprosthetic aortic valve replacement
54.3% (19/35)
66.7% (12/18)
58.5% (31/53)
– bioprosthesis + coronary artery bypass grafting
26.3% (5/19)
25.0% (3/12)
25.8% (8/31)
– bioprosthesis + surgery of ascending aorta
0% (0/19)
8.3% (1/12)
3.2% (1/31)
Mechanical aortic valve replacement
45.7% (16/35)
27.8% (5/18)
39.6% (21/53)
– mechanical prostheses + surgery of ascending aorta
37.5% (6/16)
20.0% (1/5)
33.3% (7/21)
Transcatheter aortic valve implantation
0% (0/35)
5.6% (1/18)
1.9% (1/53)
Risk factors
Average age ± standard deviation (years)
64 ± 12.4
70 ± 8.9
66.1 ± 11.6
Age range (minimum-maximum; years)
28-81
41-80
28-81
Hypertension
85.7% (30/35)
77.8% (14/18)
83.0% (44/53)
Dyslipidemia
80.0% (28/35)
66.7% (12/18)
75.5% (40/53)
Diabetes
25.7% (9/35)
11.1% (2/18)
20.8% (11/53)
Active smoking
17.1% (6/35)
27.8% (5/18)
20.8% (11/53)
Coronary artery disease
31.4% (11/35)
38.9% (7/18)
34.0% (18/53)
Mean body mass indeks (kg/m2)
28
27.9
28.2
Overweight
71.4% (25/35)
50.0% (9/18)
64.2% (34/53)
Obesity
17.1% (6/35)
22.2% (4/18)
18.9% (10/53)
Optimaly anticoagulated patients with indications (time in target range of PV/INR)
55.0% (15/27)
55.0% (5/9)
55.0% (20/36)
Conclusions: Men are more often involved in the outpatient CVR program following the aortic valve surgery. Aortic stenosis is a dominant disease, where out of risk factors there is hypertension, dyslipidemia and increased body mass index to be emphasized. Patients with implanted bioprosthetic valve were involved more frequently. Anticoagulant therapy was optimal in a half of the subjects. The CVR program after the aortic valve replacement surgery improves the functional capacity. Further studies on a greater number of patients as well as additional education about the importance of anticoagulant therapy are needed.
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