Continuous Positive Airway Pressure During Exercise Improves Walking Time in Patients Undergoing Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: Continuous positive airway pressure (CPAP) has been used as an effective support to decrease the negative pulmonary effects of coronary artery bypass graft (CABG) surgery. However, it is unknown whether CPAP can positively influence patients undergoing CABG during exercise. This study evaluated the effectiveness of CPAP on the first day of ambulation after CABG in patients undergoing inpatient cardiac rehabilitation (CR). METHODS: Fifty-four patients after CABG surgery were randomly assigned to receive either inpatient CR and CPAP (CPG) or standard CR without CPAP (CG). Cardiac rehabilitation included walking and CPAP pressures were set between 10 to 12 cmH2O. Participants were assessed on the first day of walking at rest and during walking. Outcome measures included breathing pattern variables, exercise time in seconds (ETs), dyspnea/leg effort ratings, and peripheral oxygen saturation (SpO2). RESULTS: Twenty-seven patients (13 CPG vs 14 CG) completed the study. Compared with walking without noninvasive ventilation assistance, CPAP increased ETs by 43.4 seconds (P = .040) during walking, promoted better thoracoabdominal coordination, increased ventilation during walking by 12.5 L/min (P = .001), increased SpO2 values at the end of walking by 2.6% (P = .016), and reduced dyspnea ratings by 1 point (P = .008). CONCLUSIONS: Continuous positive airway pressure can positively influence exercise tolerance, ventilatory function, and breathing pattern in response to a single bout of exercise after CABG.

Recovery of linear and nonlinear heart rate dynamics after coronary artery bypass grafting surgery.

BACKGROUND: Conventional coronary artery bypass grafting (C-CABG) and off-pump CABG (OPCAB) surgery may produce different patients' outcomes, including the extent of cardiac autonomic (CA) imbalance. The beneficial effects of an exercise-based inpatient programme on heart rate variability (HRV) for C-CABG patients have already been demonstrated by our group. However, there are no studies about the impact of a cardiac rehabilitation (CR) on HRV behaviour after OPCAB. The aim of this study is to compare the influence of both operative techniques on HRV pattern following CR in the postoperative (PO) period. METHODS: Cardiac autonomic function was evaluated by HRV indices pre- and post-CR in patients undergoing C-CABG (n = 15) and OPCAB (n = 13). All patients participated in a short-term (approximately 5 days) supervised CR programme of early mobilization, consisting of progressive exercises, from active-assistive movements at PO day 1 to climbing flights of stairs at PO day 5. RESULTS: Both groups demonstrated a reduction in HRV following surgery. The CR programme promoted improvements in HRV indices at discharge for both groups. The OPCAB group presented with higher HRV values at discharge, compared to the C-CABG group, indicating a better recovery of CA function. CONCLUSION: Our data suggest that patients submitted to OPCAB and an inpatient CR programme present with greater improvement in CA function compared to C-CABG.

Is applying the same exercise-based inpatient program to normal and reduced left ventricular function patients the best strategy after coronary surgery? A focus on autonomic cardiac response.

PURPOSE: To assess whether the same exercise-based inpatient program applied to patients with normal and reduced left ventricular function (LVF) evokes a similar cardiac autonomic response after coronary artery bypass graft (CABG). METHOD: Forty-four patients post-CABG, subgrouped according to normal LVF [LVFN: n = 23; left ventricular ejection fraction (LVEF) ≥ 55%] and reduced LVF (LVFR: n = 21; LVEF 35-54%), were included. All initiated the exercise protocol on post-operative day 1 (PO1), following a whole progressive program until discharge. Cardiac autonomic response was assessed by the indices of heart rate variability (HRV) at rest and during exercise (extremity range of motion and ambulation). RESULTS: During ambulation, lower values of HRV indices were found in the LVFR group compared with the LVFN group [standard deviation of all RR (STDRR; 6.1 ± 2.7 versus 8.9 ± 4.7 ms), baseline width of the RR histogram (TINN; 30.6 ± 14.8 versus 45.8 ± 24.9 ms), SD2 (14.8 ± 8.0 versus 21.3 ± 9.0 ms), Shannon entropy (3.6 ± 0.5 versus 3.9 ± 0.4) and correlation dimension (0.08 ± 0.2 versus 0.2 ± 0.2)]. Also, when comparing the ambulation to rest change, lower values were observed in the LVFR group for linear (STDRR, TINN, RR TRI, rMSSD) and non-linear (SD2 and correlation dimension) HRV indices (p < 0.05). On PO1, we observed only intra-group differences between rest and exercise (extremity range of motion), for mean intervals between heart beats and heart rate. CONCLUSION: For patients with LVFN, the same inpatient exercise protocol triggered a more attenuated autonomic response compared with patients with LVFR. These findings have implications as to how exercise should be prescribed according to LVF in the early stages following recovery from CABG. Implications for Rehabilitation Exercise-based inpatient program, performed by post-CABG patients who have normal left ventricular function, triggered a more attenuated cardiac autonomic response compared with patients with reduced left ventricular function. Volume of the inpatient exercises should be prescribed according to the left ventricular function in the early stages following recovery from CABG.

Left-ventricular function and autonomic cardiac adaptations after short-term inpatient cardiac rehabilitation: a prospective clinical trial.

OBJECTIVE: Cardiac rehabilitation is associated with cardiac autonomic and physiological benefits. However, it is unclear whether baseline left ventricular function (LVF) impacts on training-induced cardiac autonomic adaptations. The aim of this study was to assess the cardiac autonomic adaptations in patients with varying left ventricular function profiles undergoing coronary artery bypass grafting and cardiac rehabilitation. DESIGN: Assessor-blinded prospective trial. PATIENTS: Forty-four patients undergoing coronary artery bypass grafting, divided into normal LVFN (≥ 55%, n = 23) or reduced LVFR (35-54%, n = 21) were evaluated. METHOD: Cardiac autonomic function was evaluated by heart rate variability indexes obtained both pre- and post-cardiac rehabilitation. All patients participated in a short-term (approximately 5 days) supervised inpatient physiotherapy program. RESULTS: There were differences in heart rate variability indexes, correlation dimension and SD2 according to time and group (e.g. interaction time (effect of cardiac rehabilitation) vs group (LVFN vs LVFR), p = 0.04). Simple main effects analysis showed that the LVFR group benefited to a greater degree from cardiac rehabilitation compared with the LVFN group. Heart rate variability indexes increased significantly in the former group compared with the latter. CONCLUSION: Among post-coronary artery bypass grafting patients engaged in short-term inpatient rehabilitation, those with reduced left ventricular function are most likely to have better cardiac autonomic adaptations to exercise-based rehabilitation.

Cirurgia cardíaca para revascularização do miocárdio concomitante com ressecçäo de timoma maligno / Cardiac surgery for coronary artery bypass grafting concomitant with ressection of malignant thymoma

Uma mulher de 80 anos de idade foi submetida à cirurgia de revascularização do miocárdio. Durante a toracotomia foi encontrado tumor correspondendo a um timoma no mediastino ântero-superior que foi ressecado junto com estruturas adjacentes. A seguir foi realizada a revascularização do miocárdio com enxertos de artéria mamária interna esquerda para ramos diagonal e descendente anterior sequencialmente, e de veia safena para ramos descendente posterior e ventricular posterior da coronária direita também de modo sequencial. A paciente evoluiu bem no pós-operatório imediato, e nos seis meses de segmento ambulatorial após a cirurgia, não apresentou sinais clínicos de metástase ou miastenia graves

Miniesternotomia para a cirurgia da valva aórtica: experiência inicial / Miniesternotomy for aortic valve surgery: initial experience

We present our initial experience with minimally invasive surgery for the treatment of aortic valve diseases, through a minithoracotomy. From June to November of 1997, 12 patients underwent aortic valve replacement. The surgical technique utilized was ministernotomy from the notch to the fourth right intercostal space. There was no mortality, nor reoperation. There was necessity of complete sternotomy in one case because of difficult of leaving CPB. Late evolution was possible in 91.6 per cent of the cases and they are all free of symptons.