CONGRESS ABSTRACT

We present the case of an 80-year-old woman with severe mitral regurgitation(MR) due to ischemic cardiomyopathy,severe sarcopenia & a body-weight loss higher than 10% of usual weight,consistent for malnutrition.She needed cardiac surgery for MR but she was at extremely high surgical risk.She was addressed by cardiac anaesthesiologist to our rehabilitation clinic for pre-rehabilitation (pre-rehab) before surgery,from April 2024 to June 2024.Our pre-rehab protocol consists of specific exercises for respiratory muscles,and nutritional support. According to the initial evaluation of the rehabilitation equipe,consisting of a cardiologist,a nutritionist,a physiotherapist and a nurse,the pt needed a personalized nutritional scheme supplemented with 400ml/day of immunonutrition.She accessed our outpatient clinic on alternative days three times a week for active physioteraphy & regular medical evaluations with blood samples and routinary visits.During the 3rd week we noticed a slight body-weight increase with persistent under-performance at the Handgrip test,so we prescribed essential amino-acids alongside the nutritional scheme.One week later we stopped immunonutrition for optimal body weight status,together with the improvement in the patient’s general status.Mild renal insufficiency was stable despite the use of immunonutrition.At the end of the 6-weeks pre-rehab period,the Handgrip test improved from 8 kg in the right arm and 10.6 kg in the left arm on admission, to 13.2 kg and 14.2 kg in the right and left arm respectively.Blood samples remained within normal ranges throughout the period.Pre-surgery anxiety became evident several weeks before expected surgery,with auto-reduction of dietary intake,which we compensated by re-introducing immunonutrients in the diet.Right before surgery the handgrip test was 18.6 and 18.4 kg for the right and the left arm respectively.Cardiac anaesthesiologists re-evaluated the patient after pre-rehab with positive feedback, thus surgery was planned and undertaken on July 26th,2024.She underwent prostetic mitral valve implantation (Epic n 27) through right minithoracotomy with cannulation of the right axillary artery.She experienced delirium in the ICU, & after re-compensation of her mental status she was transferred to our inpatietns clinic for post surgical cardiac rehabilitation.She was discharged home on August 20th in good clinical conditions;since then she comes to the follow up ambulatory visits every two months.