Postoperative Pulmonary Complications in Patients With Transcatheter Tricuspid Valve Implantation—Implications for Physiotherapists

Frontiers in Cardiovascular Medicine

article

Peng-Ming Yu¹  Yu-Qiang Wang³  Ze-Ruxing Luo¹  Raymond C. C. Tsang⁴  Oystein Tronstad⁵  Jun Shi³  Ying-Qiang Guo³  Alice Y. M. Jones⁷ 

[1] Rehabilitation Medicine Center, Sichuan University West China Hospital;Key Laboratory of Rehabilitation Medicine in Sichuan Province;Department of Cardiovascular Surgery, Sichuan University West China Hospital;Department of Physiotherapy, MacLehose Medical Rehabilitation Centre;Department of Physiotherapy, The Prince Charles Hospital;Critical Care Research Group, The Prince Charles Hospital;School of Health and Rehabilitation Sciences, The University of Queensland

关键词: tricuspid regurgitation;    transcatheter tricuspid valve replacement;    pre-habilitation;    inspiratory muscle training;    physiotherapy;    postoperative pulmonary complications (PPCs);   

DOI  :  10.3389/fcvm.2022.904961

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Objectives To investigate the incidence of postoperative pulmonary complications (PPCs) and short-term recovery after transcatheter tricuspid valve implantation (TTVI). Methods A total of 17 patients diagnosed with severe tricuspid regurgitation who received a LuX-valve TTVI were included in this study. Spirometry lung function, maximal inspiratory pressure (MIP), and 6-min walk test distance (6MWD) were recorded. Prior to surgery, patients were stratified into high or low pulmonary risk groups based on published predefined criteria. A physiotherapist provided all patients with education on thoracic expansion exercises, effective cough and an inspiratory muscle training protocol at 50% of MIP for 3 days preoperatively. All patients received standard post-operative physiotherapy intervention including positioning, thoracic expansion exercises, secretion removal techniques and mobilization. Patients were assessed for PPCs as defined by the Melbourne-Group Score-version 2. Clinical characteristics and hospital stay, cost, functional capacity, and Kansas City Cardiomyopathy Questionnaire (KCCQ) heart failure score were recorded at admission, 1-week, and 30-days post-op. Results The mean ( SD ) age of the 17 patients was 68.4 (8.0) years and 15 (88%) were female. Pre-surgical assessment identified 8 patients (47%) at high risk of PPCs. A total of 9 patients (53%) developed PPCs between the 1st and 3rd day post-surgery, and 7 of these 9 patients were amongst the 8 predicted as “high risk” prior to surgery. One patient died before the 30 day follow up. Pre-operative pulmonary risk assessment score, diabetes mellitus, a low baseline MIP and 6MWD were associated with a high incidence of PPCs. Compared to those without PPCs, patients with PPCs had longer ICU and hospital stay, and higher hospitalization cost. At 30 days post-surgery, patients without PPCs maintained higher MIP and 6MWD compared to those with PPCs, but there were no significant between-group differences in other lung function parameters nor KCCQ. Conclusion This is the first study to report the incidence of PPCs post TTVI. Despite a 3-day prehabilitation protocol and standard post-operative physiotherapy, PPCs were common among patients after TTVI and significantly impacted on hospital and short-term recovery and outcomes. In the majority of patients, PPCs could be accurately predicted before surgery. A comprehensive prehabilitation program should be considered for patients prior to TTVI.

【 授权许可】

CC BY