Rehabilitation of cardiac surgery patients: a cardiac surgeon’s perspective

A modern medical rehabilitation system should consider two factors: the specific characteristics of a medical condition and the underlying pathophysiological mechanisms. This review describes the current state of the medical rehabilitation system for cardiac surgery patients, including its characteristics, issues, and future prospects. It also justifies the need for rehabilitation specialists to be involved in every stage of cardiac surgery care.

The modern medical rehabilitation system tends to transfer primary responsibility for rehabilitation activities to rehabilitation therapists. Other specialists are involved under the guidance of rehabilitation therapists to provide a multidisciplinary approach. However, the primary role of a rehabilitation therapist is not feasible because of the unique characteristics of cardiovascular diseases, significant differences in preoperative and postoperative management algorithms for patients with various cardiac surgical conditions, and inability to predict hemodynamic responses following surgical treatment. The maximum potential of extended rehabilitation is achieved through the involvement of a multidisciplinary team led by a cardiac surgeon. Other specialists, including rehabilitation therapists, should participate using not a consultative format, but a dynamic, project-based approach that considers all the specific features of a patient’s cardiac surgery and associated medical condition. This approach enables timely and effective adjustments to the rehabilitation program. The addition of a rehabilitation therapist to a cardiac surgery team led by a cardiac surgeon can significantly improve the quality and effectiveness of rehabilitation care for patients undergoing cardiac surgery.

Despite the availability of clinical guidelines, the organization of cardiac surgery rehabilitation needs to be improved. Cardiologists and cardiac surgeons often lack of awareness of the current capabilities of rehabilitation medicine and the necessity of early initiation of rehabilitation care. Moreover, the rehabilitation system does not keep pace with advancements in cardiac surgery, failing to consider the specific features of cardiac surgical conditions. The revitalization of the Russian rehabilitation system, the development of clinical guidelines regulating all stages of rehabilitation for various patient profiles, and the implementation of extended rehabilitation principles in cardiac surgical care processes remain unsystematic and unstructured. Therefore, this issue requires active research.