Rehabilitation after heart valve surgery

In Germany more than 200,000 patients suffer from congenital heart disease or acquired valvular disease, The number of patients who had valvular surgery rose from 3056 in 1979 up to 14,286 in 1998, Most of these patients participated in an inpatient postoperative rehabilitation program in order to improve symptoms, increase exercise capacity, promote vocational rehabilitation as well as social reintegration and - in elderly patients - to prevent long term nursing care, In order to achieve these goals a comprehensive inpatient rehabilitation is proposed, Routine diagnostic workup on admission should include organic and psychosocial assessments as well, For proper guidance of the physical exercise programs EGG, Doppler and ergo-spirometric stress-testing can give valuable information, Training should be supervised by ECG - or heartratemonitoring particularly in patients with mitral valve prostheses, Other important factors to be considered are left ventricular function or atrial fibrillation, In patients after aortic valve surgery heart rate is less important than valve size, pressure gradient and left ventricular mass. Comprehensive rehabilitation of valve patients should include medical therapy by a cardiologist, who coordinates programs for physical exercise, physical therapy and psychological group therapy in the context of a therapeutic team. All patients are encouraged to engage in seminars for prophylaxis of endocarditis, anticoagulation, prevention of complications by adhering to regular followup examinations, aspects of physical stresses on the job and during recreational activities, Selected patient groups are trained in the self management of oral anticoagulation, In order to practice this concept more efficiently, a special "heart valve ward" was established in 1996 in the Hohenried Clinic, Since January 1999 we are admitting also grown-up patients after surgical correction of congenital heart disease, A multicenter study for the evaluation of this concept will commence this year, Outpatient heart group therapy may be of value in maintaining a good exercise capacity and quality of life, However, exercise intensity of 1 watt/kg body weight should be restricted mainly to patients after aortic valve replacement for aortic stenosis and selected patients after mitral valve reconstruction with good left ventricular function and without atrial fibrillation, Patients with mitral valve prostheses or double valve prostheses should join low level exercise groups.