Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? There is No Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting.

Abstract

Coronary artery bypass graft (CABG) was introduced by Rene Favaloro in 19681 as the first technique for myocardial revascularization. Since then, some methodological changes have been made, such as off-pump surgery,2 hybrid revascularization (CABG and percutaneous coronary intervention),3,4 and minimally invasive direct coronary artery bypass, trying to make this procedure less aggressive or invasive, although the regular CABG performed nowadays usually still requires sternotomy and sometimes saphenectomy, because the saphenous veins are additional or alternative bypass conduits to the left and right mammary or radial arteries, the first choice because of longer patency. Response by Niebauer on p 2544 CABG is reserved today for patients with more complex coronary anatomy, defined by a Syntax score superior to 22, and in the presence of comorbidities like diabetes mellitus and renal failure.5–8 Even performed with the most modern modalities, CABG is still an important insult, associated with several potential acute-phase complications like stroke, transient neurocognitive impairment, dehiscence of sternotomy, mediastinitis, myocardial infarction, pericardial tamponade, pericarditis, hemo- or pneumothorax, pleural effusion, acute renal failure, lower limb edema, anemia, infection, and atrial fibrillation or flutter,9–11 being much more aggressive then percutaneous transluminal coronary angioplasty, the most frequently used myocardial revascularization technique. CABG usually demands an in-hospital stay close to a week and, after discharge, patients usually need a 2- to 6-week convalescence period, necessary to recover from the procedure and to normalize daily activities, including return to work if applicable. A significant proportion of patients need to overcome residual problems, like heart failure, anemia, atrial fibrillation, pulmonary abnormalities, and thoracotomy- and saphenectomy-related pain. Later in the follow-up, patients can experience recurrent angina or acute coronary syndrome (ACS) attributable to coronary artery disease progression on the native coronary circulation or to bypass failure, particularly …