Cochrane corner: Exercise-based cardiac rehabilitation for adults after heart valve surgery

Heart valve disease accounts for one‐third of all heart diseases and the prevalence is increasing due to an ageing population, population growth and advances in treatment methods.1 Heart valve diseases are mostly degenerative in nature and treatment of advanced heart valve disease includes surgery, either percutaneous or surgical valve replacement or repair. The changing disease pattern and expected increase in healthcare burden, and the large number of acute hospitalisations after valve surgery require a well‐established after‐care including cardiac rehabilitation. Issues after valve surgery also include physical and psychological issues. Physical inactivity is a problem for heart valve surgery patients, who may experience presurgical dyspnoea and physical incapacity, immobilisation during hospitalisation, and potential postsurgical complications and restrictions due to healing of the sternum. Open heart surgery is a stressful life event and health-related quality of life (HRQoL) is likely to be negatively affected, along with mental health; patients may require support for depressive symptoms and anxiety. Although such problems may also occur after percutaneous procedures, recent studies suggest that after transcatheter aortic valve replacement (TAVR), patients have much better HRQoL within 2 weeks of the procedure. Several attempts have been investigated to emphasise these issues and both European Society of Cardiology/European Association for Cardio‐Thoracic Surgery (ESC/EACTS) guidelines suggest cardiac rehabilitation after heart valve surgery.2 3 One trial has shown that individualised follow‐up programmes reduce readmissions after heart valve surgery. A meta‐analysis published in 2017 including six trials showed that participation in exercise training after TAVR can increase exercise capacity within the first year after the procedure.4 This is supported by a systematic review and meta‐analysis published in 2019 reporting that exercise‐based cardiac rehabilitation (CR) improves exercise capacity of post‐TAVR and post‐surgical aortic valve replacement (SAVR) patients in the short term.5 Current European guidelines recommend that rehabilitation after heart …