Cardiac Rehabilitation Improves Outcomes After Thoracic Aortic Aneurysm Repair

Figures

• 

  Figure 1. Flowchart of the Patient Inclusion in the Study This flowchart illustrates the selection process of patients undergoing surgery for TAA. Among the 1,745 patients who underwent TAA surgery between November 2003 and December 2015, 35 patients with connective tissue disorders (eg, Marfan syndrome, Loeys-Dietz syndrome) were excluded. Of the remaining 1,710 patients, 517 participated in outpatient CR. However, 98 patients discontinued CR within 90 days for reasons other than MACE (n = 2) or death (n = 3), leaving 419 patients in the CR group. The remaining 1,193 patients who did not participate in CR were classified as the non-CR group. CR = cardiac rehabilitation; MACE = major adverse cardiovascular events; TAA = thoracic aortic aneurysm.

• 

  Figure 2. Impact of CR on MACE Before and After Matching (A) Kaplan-Meier curves comparing the CR and non-CR groups for MACE before propensity score matching (PSM) and (B) after PSM. (C) Cox proportional hazards curves for MACE before PSM and (D) after PSM, comparing the CR and non-CR groups. Abbreviations as in Figure 1.

• 

  Figure 3. Impact of CR on All-Cause Mortality Before and After Matching (A) Kaplan-Meier curves comparing the CR and non-CR groups for all-cause mortality before PSM and (B) after PSM. (C) Cox proportional hazards curves for all-cause mortality before PSM and (d) after PSM, comparing the CR and non-CR groups. Abbreviations as in Figures 1 and 2.

• 

  Figure 4. Cox Hazards Analysis of Risk Factors for All-Cause Mortality Forest plot displaying adjusted HRs and 95% CIs for all-cause mortality derived from a multivariable Cox model in the propensity score–matched cohort. HRs >1 indicate increased risk and HRs <1 indicate decreased risk. N indicates the number of patients with each characteristic. Outpatient CR was independently associated with lower all-cause mortality. ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blockers; EF = ejection fraction; other abbreviation as in Figure 1.

• 

  Figure 5. All-Cause Mortality in Patients With a History of Former Smoking This figure presents the Kaplan-Meier survival curves for all-cause mortality in ex-smokers, stratified by participation in CR. The survival probability was estimated using the Kaplan-Meier method, and differences between the groups were assessed using the log-rank test. Ex-smokers were defined as former smokers; current smokers were not included in this analysis. Abbreviation as in Figure 1.

• 

  Central Illustration. Cardiac Rehabilitation After Thoracic Aortic Aneurysm Repair This study evaluated the impact of outpatient cardiac rehabilitation (CR) after open thoracic aortic aneurysm TAA repair in a retrospective cohort of 1,710 patients. Propensity score matching was used to compare outcomes between patients who participated in outpatient CR and those who did not. Participation in CR was associated with lower risks of major adverse cardiovascular events (MACEs) and all-cause mortality during long-term follow-up. These findings support incorporating structured CR into postoperative care after TAA repair. Downward arrows indicate reduced risk associated with CR, whereas upward arrows indicate increased risk associated with former smoking.