Preoperative Exercise Training before Elective Coronary Artery Bypass Graft Surgery: A Prospective Randomized Evaluation on Feasibility and Effects on Operative Outcomes

Background: One recommendation for patients with three vessel disease (3VD) requiring coronary artery bypass graft (CABG) surgery to avoid further symptomatic acceleration is physical inactivity. We established a safe preoperative endurance training protocol and evaluate the effects upon postoperative outcomes.

Methods: Patients with stable and asymptomatic 3VD were assessed by a heart team, gave written informed consent and were randomized to a training group (TG) and a control group (CG). Patients refusing to participate in the TG were transferred to the CG. Patients in the TG completed 6 sessions of aerobic endurance training within two weeks. Exercise intensity was set at 70% VO₂peak. An ergospirometry was performed at baseline, one day prior surgery, and at the beginning and at the end of cardiac rehabilitation. Baseline, operative and postoperative characteristics were collected.

Results: In this ongoing study, 69 patients were randomized to TG (n = 21) and CG (n = 48). Mean age was 65.5 ± 8.13 years in the training group and 68.6 ± 7.21 years in the control group. 14,3% (n = 3) patients were female in the TG and 8,8% (n = 4) in the CG. Mean number of bypass graft were 3.3 ± 1.13 in the training and 3.4 ± 0.89 in the control group. Complete revascularization was achieved in all patients, as well as the use of the left internal mammary artery. There was neither in-hospital nor 30-day mortality. Maximal oxygen consumption (VO₂max) was higher in training patients preoperatively (VO₂max: 1688 ± 490 ml/min. versus 1366 ± 333 ml/min.) and at the end of rehabilitation (VO₂max: 1381 ± 261 versus 1142 ± 337).

Conclusion: Exercise training prior CABG for patients with stable 3VD is feasible and safe for both, the pre- and postoperative period. Preliminary data trend toward a better oxygen consumption in the training group. Longer follow- up will be performed.