CONGRESS ABSTRACT

An increasing number of elderly,fragile pts with multiple comorbidities access cardiac surgery,with greater risk of complications,prolonged hospital stay,and higher 30-day postoperative mortality compared to younger pts.Frailty & high rates of comorbidities are stronger predictors of negative post surgical outcome than advanced age alone.Pre-rehabilitation (pre-rehab) is safe & effective before surgery,especially in fragile,sarcopenic pts.It favors early extubation,reduces the length of stay in the ICU,and the incidence of operation-related infections.It also allows for early discharge and improves the quality of life.In cardiology,pre-rehab includes a series of preventive interventions aimed at reducing the incidence and severity of peri- & post-operative complications and mortality.These interventions help pts access surgery in the best possible mental and physical conditions.Of note,pts with severe but stable heart disease can safely undergo physical exercise.We present our pre-rehab protocol,which aims at improving muscular mass recovery through guided physical activity,nutritional support,specific respiratory muscle training,aerobic training and the improvement of psychological well-being,to face the intervention with less anxiety.Pts access our outpatients clinic for 6 weeks,3-times-a-week,and during each access they undergo alternatively clinical evaluations,exercise sessions and meetings with the nutritionist and the psychologist.During the initial assessment,the physiotherapist sets the working program,based on a series of specific tests tailored particularly for the respiratory muscles.In fact,the correlation between sarcopenia and the reduction of lung function is extremely evident in frail pts.The pts’ nutritional status is evaluated in the first week and then every two weeks,with anthropometric measurements such as height,weight,waist and wrist circumferences,to determine skeletal size,estimation of muscle mass/strength of the upper limbs,and blood tests.Pts are interviewed about their eating habits,lifestyle,and recent weight history.A personalized diet is proposed to each pt,integrated with aminoacids & vitamins or with immunonutrition in case of deficiency statuses,weight loss > 10% of the usual weight,or frankly underweight pts.At the end of the 6-weeks,pts meet the referring cardioanaesthetist for re-evaluation.Up to now,we noticed that after pre-rehab the Euroscore improves allowing pts to undergo surgery with a lower surgical risk.