11 Cardiac rehabilitation of a 70-year-old male following tissue valve replacement

<h3>Background</h3> The 2019 UK NACR reported an increase in the number of patients recruited to UK cardiovascular rehabilitation programmes, with a broader population of patients with cardiovascular disease, including patients following valve surgery. The impact of exercise-based cardiovascular rehabilitation in this population is unclear. <h3>Aim</h3> The purpose of this case report is to demonstrate the benefits of exercise-based cardiovascular rehabilitation following tissue aortic valve replacement. <h3>Methods</h3> 70-year-old male hairdresser with a history of asthma, strong family history of aortic valve disease and increasing shortness of breath was referred for echocardiography and outpatient Cardiology clinic following presentation at the Emergency Department. The patient was playing tennis regularly until shortness of breath and one episode of syncope prevented him from playing. Clinical examination identified a loud ejection systolic murmur. Echocardiogram identified severe aortic stenosis, good systolic function and grade I diastolic dysfunction. Angiogram was unremarkable, with mild diffuse atheroma only. The patient underwent tissue aortic valve replacement. He started a supervised cardiovascular rehabilitation programme 35 days post operatively, commencing upper body exercises 6 weeks post-surgery. Outcomes were measured at baseline assessment (A1), following an 8-week supervised exercise programme (A2) and at a 6-month follow-up (A3). <h3>Results</h3> Submaximal exercise tolerance test (SETT) METs increased from 5.3 (A1) to 6.7 (A2) to 7.2 (A3); BMI reduced from 27.6 kg/m2 (A1) to 27.2 kg/m2 (A2) to 26.8 kg/m2 (A3); Duke Activity Status Index improved from 32.7 (A1) to 58.2 (A2) and unchanged at 58.2 at A3. The patient returned to tennis 13-weeks post-surgery. There were no surgery-related adverse events (e.g., arrhythmias, arterial embolism, death), nor adverse events associated with valve disease (e.g. any arrhythmias, heart failure, death). <h3>Conclusion</h3> This case report highlights how cardiovascular rehabilitation can positively affect physical recovery following valve surgery; it may benefit other patient groups not routinely referred to cardiac rehabilitation.