What activities can a patient perform from bed on post-operative day 2 and 3 after mitral valve repair to regain strength and practice deep breathing, despite being connected to a chest tube, Foley (urinary) catheter, and central line?

From the Guidelines

On post-operative days 2 and 3 after a mitral valve repair, ICU patients should engage in activities from their bed to regain strength and practice deep breathing, despite being connected to medical devices, as this significantly reduces recovery time and decreases the risk of complications associated with prolonged immobility. These activities can include incentive spirometry, performed 10 times every hour while awake, taking slow deep breaths and holding for 3-5 seconds before exhaling, as recommended by general medical practice and supported by the principles outlined in 1. Some key exercises and activities that can be done from bed include:

• Ankle pumps (flexing and pointing feet) and gentle leg raises, done 10-15 times hourly to maintain circulation and prevent blood clots
• Isometric exercises by tightening and releasing different muscle groups (quadriceps, gluteal muscles, abdominals) for 5-10 seconds, repeating 5-10 times several times daily
• Assisted sitting up in bed and eventually dangling legs at bedside with help from nursing staff
• Arm exercises like gentle bicep curls using small weights (1-2 pounds) or even a rolled towel to help maintain upper body strength The importance of early mobilization is also highlighted in 1, which, although focused on a different surgical context, emphasizes the value of active mobilization from the first postoperative day. While the specific context of mitral valve repair may not be directly addressed in the provided evidence, the general principles of preventing deconditioning and promoting recovery through early activity apply broadly across surgical recoveries, as noted in guidelines such as those found in 1. Deep breathing exercises, in particular, are crucial for re-expanding the lungs after surgery, preventing atelectasis, and improving oxygenation, as discussed in 1, which details breathing exercises as part of pain management strategies in ICU patients. By starting these activities early, even while connected to medical equipment, patients can significantly improve their outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Post-Operative Care for Mitral Valve Repair Patients

On post-op day 2 and 3, ICU patients who have undergone mitral valve repair can engage in various activities from their bed to help regain strength and practice deep breathing, despite being connected to a chest tube, Foley catheter, or central line. These activities include:

• Deep breathing exercises to improve lung function and inspiratory muscle strength, as shown in a study on postoperative high-load long-duration inspiratory muscle training 2
• Inspiratory muscle training, which can start as early as the first day in the inpatient ward, with a target load of 80% of the baseline maximal inspiratory pressure by the end of the 8-week intervention protocol 2
• Gradual mobilization and physical therapy to prevent deconditioning and improve functional capacity, although the exact protocol may vary depending on the patient's condition and the hospital's guidelines

Considerations for Mitral Valve Repair Patients

It is essential to note that mitral valve repair patients may experience complications such as systolic anterior motion (SAM), which can occur intraoperatively or postoperatively 3. A systematic approach to managing SAM can yield excellent mid-term results. Additionally, the choice of surgical technique, such as leaflet plication or triangular resection, can impact the outcome of the repair 4.

Techniques for Mitral Valve Re-repair

In cases where mitral valve repair fails, re-repair may be a viable option 5. The mechanisms of mitral valve repair failure and factors influencing the likelihood of a successful re-repair should be considered. Techniques for re-repair, such as those illustrated in 5, can be used to achieve reliable success.

Review of Mitral Valve Insufficiency

Mitral valve insufficiency can be caused by various factors, including degenerative changes, cardiac ischemia, infective endocarditis, and rheumatic disease 6. The best outcomes after repair of severe degenerative mitral regurgitation are achieved in asymptomatic or minimally symptomatic patients who are selected for surgery soon after diagnosis.