Cardiovascular rehabilitation of patients undergoing coronary bypass surgery
PDF (Português (Brasil))

Keywords

Cardiac Rehabilitation
Cardiovascular Surgery
Coronary Circulation
Myocardial Revascularization

How to Cite

Nogueira, R. A., Ferreira, H. V. V., Barcelos , M. G. R., Moreira, J. M. do P., Neto, G. P. C., Júnior , P. D., Américo , J. A., Almeida , L. L., Pacheco , G. R., Aguiar , J. S., Paes , A. G., Bessa, H. J. M., & Maciel , T. dos S. (2024). Cardiovascular rehabilitation of patients undergoing coronary bypass surgery. Brazilian Journal of Implantology and Health Sciences, 6(7), 598–616. https://doi.org/10.36557/2674-8169.2024v6n7p598-616

Abstract

Myocardial revascularization is a widely sought-after surgical procedure on a global level, due to the reduction or interruption of blood flow to some cardiac regions, leading to myocardial ischemia. Despite the high recurrence and morbidity related to cardiovascular diseases, mortality from this group of pathologies has decreased in recent years. Contrary to this, the number of patients undergoing coronary bypass surgery has increased considerably in the last decade, given the increase in life expectancy, which leads to vascular alterations resulting from the senescence process, as well as the growing diagnosis of baseline and chronic cardiovascular diseases, such as hypertension, diabetes mellitus and dyslipidemia. Thus, in view of the increase in the number of coronary bypass surgeries performed worldwide, as well as the high potential for morbidity and mortality associated with cardiovascular diseases in the intra- and post-operative periods, this article aims to understand the importance and role of cardiovascular rehabilitation in the recovery of surgical patients, in order to reintegrate them into the social context, as well as enabling a gradual return to normal activities. To this end, a literature review was carried out by collecting original and review articles published in English and Portuguese over the last 25 years from the SciELO and PubMed bibliographic reference databases, which increases the reliability of the study. After analyzing the articles, it emerged that cardiovascular rehabilitation is fundamental in the postoperative period of patients undergoing coronary artery bypass grafting and involves a multidisciplinary approach, focused on physiotherapeutic rehabilitation, supervised physical exercise, lifestyle and dietary changes, as well as psychological support. Rehabilitation, when done properly, significantly reduces mortality, reduces morbidity and, consequently, minimizes the risk of new cardiovascular events. Thus, post-operative rehabilitation guarantees not only the early reintegration of the individual into the social environment and normal activities, but also improves functional capacity, reduces recurrent cardiovascular risk and provides physical and mental well-being for revascularized patients.

https://doi.org/10.36557/2674-8169.2024v6n7p598-616
PDF (Português (Brasil))

References

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet, 2004;364(9438):937-952. doi: 10.1016/S0140-6736(04)17018-9

Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature, 2011;473(7347):317-325. doi: 10.1038/nature10146

Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. New England Journal of Medicine, 2005;352(16):1685-1695. doi: 10.1056/NEJMra043430

Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. New England Journal of Medicine, 2010;326(4):242-250. doi: 10.1056/NEJM199201233260406

Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 2012;60(24):e44-e164. doi: 10.1016/j.jacc.2012.07.013

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 2014;35(37):2541-2619. doi: 10.1093/eurheartj/ehu278

Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. On-pump versus off-pump coronary-artery bypass surgery. New England Journal of Medicine, 2009;361(19):1827-1837. doi: 10.1056/NEJMoa0902905

Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011;124(23):2610-2642. doi: 10.1161/CIR.0b013e31823b5fee

Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. The Cochrane Database of Systematic Reviews, 2016;(1), CD001800. doi: 10.1002/14651858.CD001800.pub3

Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, et al. Exercise-based cardiac rehabilitation for coronary heart disease. The Cochrane Database of Systematic Reviews, 2011;(7), CD001800. doi: 10.1002/14651858.CD001800.pub2

Gomes F, Telo DF, Souza HP, Nicolau JC, Halpern A, Serrano Jr CV. Obesidade e doença arterial coronariana: papel da inflamação vascular. Arq bras cardiol, 2010;94:273-279. doi: 10.1590/S0066-782X2010000200021

Gus I, Fischmann A, Medina C. Prevalência dos fatores de risco da doença arterial coronariana no Estado do Rio Grande do Sul. Arq bras cardiol, 2002;78(5):478-83.

Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. Journal of the American College of Cardiology, 2020;70(1):1-25. doi: 10.1016/j.jacc.2017.04.052

Coelho AC, de Lima Lopes J, Santos VB, de Barros ALBL. Fatores de risco da doença arterial coronariana dos familiares conviventes de indivíduos com síndrome coronariana aguda. REME-Revista Mineira de Enfermagem, 2016;20(1). doi: 10.35699/2316-9389.2016.50008

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP,et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 2019;139(10):e56-e528. doi: 10.1161/CIR.0000000000000659

Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Journal of the American College of Cardiology, 2011;58(23):2432-2446. doi: 10.1016/j.jacc.2011.10.824

Monteiro G, Staico R, Araújo W, Costa R, Chaves Á, Feres F. Realização de angioplastia coronária com volume total de três mililitros de contraste. Revista Brasileira de Cardiologia Invasiva, 2011;19:452-455. doi: 10.1590/S2179-83972011000400019

Piegas LS, Bittar OJNV, Haddad N. Cirurgia de revascularização miocárdica: resultados do Sistema Único de Saúde. Arq Bras Cardiol, 2009;93:555-560. doi: 10.1590/S0066-782X2009001100018

Koerich C, Baggio MA, Erdmann AL, Lanzoni GMDM, Higashi GDC. Revascularização miocárdica: estratégias para o enfrentamento da doença e do processo cirúrgico. Acta Paulista de Enfermagem, 2013;26:8-13. doi: 10.1590/S0103-21002013000100003

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation, 2016;133(4):e38-e360. doi: 10.1161/CIR.0000000000000350

Souza DSRD, Gomes WJ. O futuro da veia safena como conduto na cirurgia de revascularização miocárdica. Brazilian Journal of Cardiovascular surgery, 2008;23(3):5p. doi: 10.1590/S0102-76382008000300002

Mohr FW, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. The Lancet, 2013;381(9867):629-638. doi: 10.1016/S0140-6736(13)60141-5

Head SJ, Milojevic M, Daemen J, Ahn JM. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention, 2018;13(12):e1185-e1194. doi: 10.4244/EIJ-D-17-00757

Barros FS, Pontes SM, Lima ML, Henrique JS, Roldi ML, Reis F, et al. Mapeamento da safena interna com ecocolor Doppler no pré-operatório de cirurgia de revascularização miocárdica. Brazilian Journal of Cardiovascular Surgery, 1999;14:303-307. doi: 10.1590/S0102-76381999000400005

Rueda FD, Souza D, Lima RDC, Menezes A, Johansson B, Dashwood M, et al. Nova técnica cirúrgica de preparo da veia safena para revascularização do miocárdio sem manipulação direta-no-touch. Arq Bras Cardiol, 2008;90:388-395. doi: 10.1590/S0066-782X2008000600002

Godinho AS, Alves AS, Pereira AJ, Pereira TS. Cirurgia de revascularização miocárdica com circulação extracorpórea versus sem circulação extracorpórea: uma metanálise. Arq Bras Cardiol, 2012;98:87-94. doi: 10.1590/S0066-782X2012000100014

Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, et al. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA, 2007;297(7):701-708. doi: 10.1001/jama.297.7.701

Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. The Annals of Thoracic Surgery, 2003;75(3):840-846. doi: 10.1016/S0003-4975(02)04731-6

Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. New England Journal of Medicine, 2001;344(6):395-402. doi: 10.1056/NEJM200102083440601

Brown CH, Probert J, Healy R, Parish M, Nomura Y, Yamaguchi A, et al. Cognitive decline after delirium in patients undergoing cardiac surgery. Anesthesia & Analgesia, 2016;123(2):436-444. doi: 10.1213/ANE.0000000000001233

Piepoli MF, Corra U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, et al. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. European Heart Journal, 2010;31(16):1967-1976. doi: 10.1093/eurheartj/ehq236

Huang Y, Wu M, Wu H, Chen Y, Peng C. Effectiveness of a rehabilitation program after coronary artery bypass grafting. Clinical Rehabilitation, 2013;27(6):496-503. doi: 10.1177/0269215512469410

Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Rehabilitation in Orthopedic Surgery: A Systematic Review. Journal of Surgical Research, 2017;209:23-30. doi: 10.1016/j.jss.2016.09.040

Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E, et al. Functional impact of 10 days of bed rest in healthy older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008;63(10):1076-1081. doi: 10.1093/gerona/63.10.1076

Oldridge N, Pakosh M, Thomas RJ. Cardiac rehabilitation after coronary artery bypass graft surgery: a systematic review and meta-analysis. Annals of Thoracic Surgery, 2011;92(6):1907-1916. doi: 10.1016/j.athoracsur.2011.06.007

Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. American Journal of Medicine, 2004;116(10):682-692. doi: 10.1016/j.amjmed.2004.01.009

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. Journal of the American College of Cardiology, 2009;53(21):1925-1932. doi: 10.1016/j.jacc.2008.12.068

Hansen D, Dendale P, Raskin A, Schoonis A, Berger J, Meeusen R. Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume. Clinical Rehabilitation, 2015;29(3):289-298. doi: 10.1177/0269215514542351

Aikawa P, Cintra ARS, Oliveira ASD, Silva CTMD, Pierucci JD, Afonso MDS, et al. Reabilitação cardíaca em pacientes submetidos à cirurgia de revascularização do miocárdio. Revista Brasileira de Medicina do Esporte, 2014;20(01):55-58. doi: 10.1590/S1517-86922014000100011

Doyle L, MacKay-Lyons M. Utilization of aerobic exercise in adult neurological rehabilitation by physical therapists in Canada. Journal of neurologic physical therapy, 2013;37(1):20-26. doi: 10.1097/NPT.0b013e318282975c

Nonato EA, Moreira JFP, Borges LMS, Maciel FL. Eficácia dos exercícios aeróbicos na reabilitação de pacientes no pós- operatório de cirurgia cardíaca. Revista ft, 2023;27. doi: 10.5281/zenodo.10019428

Yohannes AM, Yalfani A, Doherty P, Bundy C. Predictors of drop-out from an outpatient cardiac rehabilitation programme. Clinical Rehabilitation, 2010;24(8):726-736. doi: 10.1177/0269215510367999

Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. NEJM, 2018;378(25):e34. doi: 10.1056/NEJMoa1800389

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2024 Rayssa Almeida Nogueira, Hian Victor Vieira Ferreira, Mariah Gomes Rangel Barcelos , Júlia Maria do Prado Moreira, Geraldo Pereira Cova Neto, Pedro Delazare Júnior , Judith Amaral Américo , Lavínia Lages Almeida , Guilherme Rodrigues Pacheco , Júlia Silveira Aguiar , Ana Gabriela Paes , Heloisa Jocastra Morais Bessa, Thiago dos Santos Maciel