[Initial clinical experience of early cardiac rehabilitation for very elderly patients over 85 years old following open heart surgery].

In this study, we evaluated the initial clinical experience of early cardiac rehabilitation( CR) for very elderly patients over 85 years old after open heart surgery. From September 2007 to January 2011, 7 consecutive patients (85~90 years, mean 85.9 years, male:female=4:3) who underwent cardiac surgery in our institute were selected. Preoperative activity of daily living (ADL) scores were similar in all cases, and 1 patient used a cane for walking. Preoperative New York Heart Association (NYHA) classification was class III :3, class IV:4. Three patients were admitted for acute congestive heart failure approximately 1 month prior to surgery. Standard open heart surgery using bioprosthesis was performed: 3 patients underwent mitral valve replacement( MVR), 3 had aortic valve replacement( AVR), and 1 had tricuspid valve replacement (TVR). Postoperative clinical course was uneventful, and the mean time of ventilator support was 12.1 hours. Thereafter, early CR was introduced at the intensive care unit( ICU) in all patients, and the mean time of introduction of early rehabilitation was 1.7 days. In the last 4 cases, early CR was done the 1st day following surgery. CR was effectively performed in all cases without any problems or cardiac events, and all patients improved enough to leave their beds at 3~7 days, a mean of 4.4 days after surgery. The mean hospital stay after surgery was 30.9 days( 23 ~ 42 days), almost all patients were able to walk independently, and ADL scores at discharge were improved. Only 2 patients required a cane for walking. Postoperative NYHA classification was improved to class I :5, class II :2. From these results, early CR for very elderly patients over 85 years old could be a safe and effective tool to improve and maintain the ADL and quality of life following surgical intervention.