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.