From the Guidelines
Cardiac rehabilitation exercise programs for post-mitral valve repair surgery patients should include a multidisciplinary approach with a focus on exercise training, education, and lifestyle modification, as recommended by the European Heart Journal in 2005 1. The program should be tailored to the individual patient's needs and abilities, taking into account their post-operative course and any complications that may have arisen.
- Key components of the program include:
- Baseline echocardiography to assess cardiac function and guide exercise recommendations
- Education on anticoagulation, symptom recognition, and healthy lifestyle habits
- Exercise training, which should be supervised and gradual, with a focus on aerobic exercise, light resistance training, and flexibility exercises
- Monitoring of exercise intensity using the Borg Rating of Perceived Exertion scale
- Patients who are good candidates for exercise training include those with preserved left ventricular function and no residual pulmonary hypertension, as noted in the study 1.
- The program should be conducted on an inpatient or outpatient basis, depending on the availability of local facilities and the patient's recovery pattern, as suggested by the study 1.
- A submaximal exercise test should be performed about 2 weeks after surgery to guide detailed exercise recommendations and ensure a safe and effective rehabilitation program.
From the Research
Cardiac Rehab Exercise Programs for Post-Mitral Valve Repair Surgery Patients
- There is limited evidence to support routine cardiac rehabilitation in individuals post-valve surgery or intervention, but it may be considered on a case-by-case basis 2
- Patients post-valve intervention or surgery are best treated in a dedicated valve clinic where they can undergo clinical review and surveillance echocardiography, be provided with heart valve education, and have access to the multidisciplinary valve team if needed 2
- Guideline-directed medical therapy for coexistent heart failure should be optimized, and cardiovascular risk factors such as hyperlipidaemia, hypertension, and diabetes should be treated in the same way as those without valve intervention 2
- Patients should be encouraged to exercise regularly, eat healthily, and maintain a healthy weight 2
Medical Treatment and Outcome after Mitral Valve Repair
- Continuous beta-blocker therapy may be considered in patients after bioprosthetic mitral valve replacement to delay structural valve deterioration and improve prosthetic durability 3
- Optimization of guideline-directed medical therapy in reduced ejection fraction heart failure is associated with improved survival and can reduce the severity of secondary mitral regurgitation 4
- Downtitration of guideline-directed medical therapy after percutaneous mitral valve repair is associated with poor prognosis 4
Percutaneous Repair of Mitral Valve Regurgitation
- Percutaneous mitral valve repair using MitraClip can result in reduction of mitral regurgitation and significant additional cardiac reverse remodelling compared to optimal medical therapy only 5
- Both optimal medical therapy and percutaneous mitral valve repair can cause cardiac reverse remodelling and relief of symptoms in patients with heart failure and severe mitral regurgitation 5
Techniques for Mitral Valve Re-repair
- Mitral valve re-repair is a valid clinical consideration in cases of valve repair failure, and techniques for re-repair have been developed and illustrated with reliable success 6
- The mechanisms of mitral valve repair failure and factors that influence the likelihood of a successful re-repair should be considered when deciding on a treatment plan 6