Effects of preoperative inspiratory muscle training on prevention of postoperative pulmonary complications in patients undergoing transcatheter tricuspid valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yuqiang ¹ , YU Pengming ^2,3 , HE Chengqi ^2,3 , CHEN Miao ¹ , SHI Jun ¹ ,  GUO Yingqiang ¹

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Rehabilitation Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China;

Corresponding author：

GUO Yingqiang, Email: drguoyq@hotmail.com

Keywords：

Transcatheter tricuspid valve replacement; inspiratory muscle training; postoperative pulmonary complications; rehabilitation

DOI：

10.7507/1007-4848.202011054

Video：

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Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.

Citation： WANG Yuqiang, YU Pengming, HE Chengqi, CHEN Miao, SHI Jun, GUO Yingqiang. Effects of preoperative inspiratory muscle training on prevention of postoperative pulmonary complications in patients undergoing transcatheter tricuspid valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1087-1092. doi: 10.7507/1007-4848.202011054 Copy

1.	Taramasso M, Gavazzoni M, Pozzoli A, et al. Tricuspid regurgitation: Predicting the need for intervention, procedural success, and recurrence of disease. JACC Cardiovasc Imaging, 2019, 12(4): 605-621.
2.	Taramasso M, Alessandrini H, Latib A, et al. Outcomes after current transcatheter tricuspid valve intervention: Mid-term results from the international TriValve registry. JACC Cardiovasc Interv, 2019, 12(2): 155-165.
3.	Lu FL, Ma Y, An Z, et al. First-in-man experience of transcatheter tricuspid valve replacement with LuX-Valve in high-risk tricuspid regurgitation patients. JACC Cardiovasc Interv, 2020, 13(13): 1614-1616.
4.	Ibañez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
5.	Gomes Neto M, Martinez BP, Reis HF, et al. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: Systematic review and meta-analysis. Clin Rehabil, 2017, 31(4): 454-464.
6.	Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg, 2006, 132(6): 1258-1261.
7.	Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
8.	Rodés-Cabau J, Hahn RT, Latib A, et al. Transcatheter therapies for treating tricuspid regurgitation. J Am Coll Cardiol, 2016, 67(15): 1829-1845.
9.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
10.	PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology, Hemmes SN, Gama de Abreu M, et al. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): A multicentre randomised controlled trial. Lancet, 2014, 384(9942): 495-503.
11.	Brown PP, Kugelmass AD, Cohen DJ, et al. The frequency and cost of complications associated with coronary artery bypass grafting surgery: Results from the United States Medicare program. Ann Thorac Surg, 2008, 85(6): 1980-1986.
12.	da Costa Torres D, Dos Santos PM, Reis HJ, et al. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol. SAGE Open Med, 2016, 4: 2050312116682256.
13.	Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: A randomized controlled trial. Eur J Cardiothorac Surg, 2016, 49(5): 1483-1491.
14.	Siafakas NM, Mitrouska I, Bouros D, et al. Surgery and the respiratory muscles. Thorax, 1999, 54(5): 458-465.
15.	Brescia AA, Ward ST, Watt TMF, et al. Outcomes of guideline-directed concomitant annuloplasty for functional tricuspid regurgitation. Ann Thorac Surg, 2020, 109(4): 1227-1232.
16.	Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: The past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg, 2012, 143(5): 1043-1049.
17.	Kim JB, Jung SH, Choo SJ, et al. Clinical and echocardiographic outcomes after surgery for severe isolated tricuspid regurgitation. J Thorac Cardiovasc Surg, 2013, 146(2): 278-284.
18.	Kim YJ, Kwon DA, Kim HK, et al. Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation, 2009, 120(17): 1672-1678.
19.	Doenst T, Bargenda S, Kirov H, et al. Cardiac surgery 2019 reviewed. Thorac Cardiovasc Surg, 2020, 68(5): 363-376.
20.	Cargnin C, Karsten M, Guaragna JCVDC, et al. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: A randomized controlled trial. J Cardiopulm Rehabil Prev, 2019, 39(5): E1-E7.
21.	Illi SK, Held U, Frank I, et al. Effect of respiratory muscle training on exercise performance in healthy individuals: A systematic review and meta-analysis. Sports Med, 2012, 42(8): 707-724.
22.	Cordeiro AL, de Melo TA, Neves D, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg, 2016, 31(2): 140-144.
23.	Kodric M, Trevisan R, Torregiani C, et al. Inspiratory muscle training for diaphragm dysfunction after cardiac surgery. J Thorac Cardiovasc Surg, 2013, 145(3): 819-823.
24.	Mancini DM, Henson D, LaManca J, et al. Respiratory muscle function and dyspnea in patients with chronic congestive heart failure. Circulation, 1992, 86(3): 909-918.
25.	Zheng YT, Zhang JX. Preoperative exercise and recovery after cardiac surgery: A meta-analysis. BMC Cardiovasc Disord, 2020, 20(1): 2.
26.	Hill K, Cecins NM, Eastwood PR, et al. Inspiratory muscle training for patients with chronic obstructive pulmonary disease: A practical guide for clinicians. Arch Phys Med Rehabil, 2010, 91(9): 1466-1470.
27.	McConnell AK. The role of inspiratory muscle function and training in the genesis of dyspnoea in asthma and COPD. Prim Care Respir J, 2005, 14(4): 186-194.
28.	Nardi P, Pisano C, Altieri C, et al. The benefit of a preoperative respiratory protocol and musculoskeletal exercise in patients undergoing cardiac surgery. Kardiochir Torakochirurgia Pol, 2020, 17(2): 94-100.
29.	Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg, 2004, 199(5): 762-772.
30.	Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin, 2015, 33(1): 17-33.
31.	Waite I, Deshpande R, Baghai M, et al. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg, 2017, 12(1): 91.
32.	Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: A systematic review. JBI Database System Rev Implement Rep, 2015, 13(1): 146-187.
33.	Valkenet K, van de Port IG, Dronkers JJ, et al. The effects of preoperative exercise therapy on postoperative outcome: A systematic review. Clin Rehabil, 2011, 25(2): 99-111.
34.	Kawauchi TS, Umeda IIK, Braga LM, et al. Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial. Clin Res Cardiol, 2017, 106(9): 676-685.
35.	Hossein Pour AH, Gholami M, Saki M, et al. The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial. Jpn J Nurs Sci, 2020, 17(2): e12290.
36.	Chen X, Hou L, Zhang Y, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: A randomized controlled trial. Clin Rehabil, 2019, 33(5): 913-922.
37.	Palau P, Domínguez E, López L, et al. Inspiratory muscle training and functional electrical stimulation for treatment of heart failure with preserved ejection fraction: The TRAINING-HF trial. Rev Esp Cardiol (Engl Ed), 2019, 72(4): 288-297.
38.	Moreno AM, Toledo-Arruda AC, Lima JS, et al. Inspiratory muscle training improves intercostal and forearm muscle oxygenation in patients with chronic heart failure: Evidence of the origin of the respiratory metaboreflex. J Card Fail, 2017, 23(9): 672-679.
39.	Miozzo AP, Stein C, Marcolino MZ, et al. Effects of high-intensity inspiratory muscle training associated with aerobic exercise in patients undergoing CABG: Randomized clinical trial. Braz J Cardiovasc Surg, 2018, 33(4): 376-383.
40.	Dos Santos TD, Pereira SN, Portela LOC, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol, 2019, 279: 40-46.
41.	Turky K, Afify AMA. Effect of preoperative inspiratory muscle training on alveolar-arterial oxygen gradients after coronary artery bypass surgery. J Cardiopulm Rehabil Prev, 2017, 37(4): 290-294.
42.	Lai Y, Huang J, Yang M, et al. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: A randomized controlled trial. J Surg Res, 2017, 209: 30-36.
43.	Cipriano GF, Cipriano G, Santos FV, et al. Current insights of inspiratory muscle training on the cardiovascular system: A systematic review with meta-analysis. Integr Blood Press Control, 2019, 12: 1-11.
44.	Markov G, Spengler CM, Knöpfli-Lenzin C, et al. Respiratory muscle training increases cycling endurance without affecting cardiovascular responses to exercise. Eur J Appl Physiol, 2001, 85(3-4): 233-239.
45.	Kubitz JC, Schulte-Uentrop L, Zoellner C, et al. Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery. PLoS One, 2020, 15(4): e0231378.
46.	Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced recovery after surgery society recommendations. JAMA Surg, 2019, 154(8): 755-766.

1. Taramasso M, Gavazzoni M, Pozzoli A, et al. Tricuspid regurgitation: Predicting the need for intervention, procedural success, and recurrence of disease. JACC Cardiovasc Imaging, 2019, 12(4): 605-621.
2. Taramasso M, Alessandrini H, Latib A, et al. Outcomes after current transcatheter tricuspid valve intervention: Mid-term results from the international TriValve registry. JACC Cardiovasc Interv, 2019, 12(2): 155-165.
3. Lu FL, Ma Y, An Z, et al. First-in-man experience of transcatheter tricuspid valve replacement with LuX-Valve in high-risk tricuspid regurgitation patients. JACC Cardiovasc Interv, 2020, 13(13): 1614-1616.
4. Ibañez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
5. Gomes Neto M, Martinez BP, Reis HF, et al. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: Systematic review and meta-analysis. Clin Rehabil, 2017, 31(4): 454-464.
6. Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg, 2006, 132(6): 1258-1261.
7. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
8. Rodés-Cabau J, Hahn RT, Latib A, et al. Transcatheter therapies for treating tricuspid regurgitation. J Am Coll Cardiol, 2016, 67(15): 1829-1845.
9. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
10. PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology, Hemmes SN, Gama de Abreu M, et al. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): A multicentre randomised controlled trial. Lancet, 2014, 384(9942): 495-503.
11. Brown PP, Kugelmass AD, Cohen DJ, et al. The frequency and cost of complications associated with coronary artery bypass grafting surgery: Results from the United States Medicare program. Ann Thorac Surg, 2008, 85(6): 1980-1986.
12. da Costa Torres D, Dos Santos PM, Reis HJ, et al. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol. SAGE Open Med, 2016, 4: 2050312116682256.
13. Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: A randomized controlled trial. Eur J Cardiothorac Surg, 2016, 49(5): 1483-1491.
14. Siafakas NM, Mitrouska I, Bouros D, et al. Surgery and the respiratory muscles. Thorax, 1999, 54(5): 458-465.
15. Brescia AA, Ward ST, Watt TMF, et al. Outcomes of guideline-directed concomitant annuloplasty for functional tricuspid regurgitation. Ann Thorac Surg, 2020, 109(4): 1227-1232.
16. Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: The past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg, 2012, 143(5): 1043-1049.
17. Kim JB, Jung SH, Choo SJ, et al. Clinical and echocardiographic outcomes after surgery for severe isolated tricuspid regurgitation. J Thorac Cardiovasc Surg, 2013, 146(2): 278-284.
18. Kim YJ, Kwon DA, Kim HK, et al. Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation, 2009, 120(17): 1672-1678.
19. Doenst T, Bargenda S, Kirov H, et al. Cardiac surgery 2019 reviewed. Thorac Cardiovasc Surg, 2020, 68(5): 363-376.
20. Cargnin C, Karsten M, Guaragna JCVDC, et al. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: A randomized controlled trial. J Cardiopulm Rehabil Prev, 2019, 39(5): E1-E7.
21. Illi SK, Held U, Frank I, et al. Effect of respiratory muscle training on exercise performance in healthy individuals: A systematic review and meta-analysis. Sports Med, 2012, 42(8): 707-724.
22. Cordeiro AL, de Melo TA, Neves D, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg, 2016, 31(2): 140-144.
23. Kodric M, Trevisan R, Torregiani C, et al. Inspiratory muscle training for diaphragm dysfunction after cardiac surgery. J Thorac Cardiovasc Surg, 2013, 145(3): 819-823.
24. Mancini DM, Henson D, LaManca J, et al. Respiratory muscle function and dyspnea in patients with chronic congestive heart failure. Circulation, 1992, 86(3): 909-918.
25. Zheng YT, Zhang JX. Preoperative exercise and recovery after cardiac surgery: A meta-analysis. BMC Cardiovasc Disord, 2020, 20(1): 2.
26. Hill K, Cecins NM, Eastwood PR, et al. Inspiratory muscle training for patients with chronic obstructive pulmonary disease: A practical guide for clinicians. Arch Phys Med Rehabil, 2010, 91(9): 1466-1470.
27. McConnell AK. The role of inspiratory muscle function and training in the genesis of dyspnoea in asthma and COPD. Prim Care Respir J, 2005, 14(4): 186-194.
28. Nardi P, Pisano C, Altieri C, et al. The benefit of a preoperative respiratory protocol and musculoskeletal exercise in patients undergoing cardiac surgery. Kardiochir Torakochirurgia Pol, 2020, 17(2): 94-100.
29. Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg, 2004, 199(5): 762-772.
30. Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin, 2015, 33(1): 17-33.
31. Waite I, Deshpande R, Baghai M, et al. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg, 2017, 12(1): 91.
32. Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: A systematic review. JBI Database System Rev Implement Rep, 2015, 13(1): 146-187.
33. Valkenet K, van de Port IG, Dronkers JJ, et al. The effects of preoperative exercise therapy on postoperative outcome: A systematic review. Clin Rehabil, 2011, 25(2): 99-111.
34. Kawauchi TS, Umeda IIK, Braga LM, et al. Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial. Clin Res Cardiol, 2017, 106(9): 676-685.
35. Hossein Pour AH, Gholami M, Saki M, et al. The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial. Jpn J Nurs Sci, 2020, 17(2): e12290.
36. Chen X, Hou L, Zhang Y, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: A randomized controlled trial. Clin Rehabil, 2019, 33(5): 913-922.
37. Palau P, Domínguez E, López L, et al. Inspiratory muscle training and functional electrical stimulation for treatment of heart failure with preserved ejection fraction: The TRAINING-HF trial. Rev Esp Cardiol (Engl Ed), 2019, 72(4): 288-297.
38. Moreno AM, Toledo-Arruda AC, Lima JS, et al. Inspiratory muscle training improves intercostal and forearm muscle oxygenation in patients with chronic heart failure: Evidence of the origin of the respiratory metaboreflex. J Card Fail, 2017, 23(9): 672-679.
39. Miozzo AP, Stein C, Marcolino MZ, et al. Effects of high-intensity inspiratory muscle training associated with aerobic exercise in patients undergoing CABG: Randomized clinical trial. Braz J Cardiovasc Surg, 2018, 33(4): 376-383.
40. Dos Santos TD, Pereira SN, Portela LOC, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol, 2019, 279: 40-46.
41. Turky K, Afify AMA. Effect of preoperative inspiratory muscle training on alveolar-arterial oxygen gradients after coronary artery bypass surgery. J Cardiopulm Rehabil Prev, 2017, 37(4): 290-294.
42. Lai Y, Huang J, Yang M, et al. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: A randomized controlled trial. J Surg Res, 2017, 209: 30-36.
43. Cipriano GF, Cipriano G, Santos FV, et al. Current insights of inspiratory muscle training on the cardiovascular system: A systematic review with meta-analysis. Integr Blood Press Control, 2019, 12: 1-11.
44. Markov G, Spengler CM, Knöpfli-Lenzin C, et al. Respiratory muscle training increases cycling endurance without affecting cardiovascular responses to exercise. Eur J Appl Physiol, 2001, 85(3-4): 233-239.
45. Kubitz JC, Schulte-Uentrop L, Zoellner C, et al. Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery. PLoS One, 2020, 15(4): e0231378.
46. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced recovery after surgery society recommendations. JAMA Surg, 2019, 154(8): 755-766.

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Effects of preoperative inspiratory muscle training on prevention of postoperative pulmonary complications in patients undergoing transcatheter tricuspid valve replacement

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