Cardiac Rehabilitation Improves Outcomes After Thoracic Aortic Aneurysm Repair

BACKGROUND: Cardiac rehabilitation (CR) improves prognosis in patients with ischemic heart disease and heart failure. However, its effectiveness in aortic diseases, such as thoracic aortic aneurysms (TAA), remains unclear. OBJECTIVES: This study aimed to evaluate the effects of outpatient CR on major adverse cardiovascular events (MACEs) and all-cause mortality after open repair surgery for TAA. METHODS: This retrospective cohort study analyzed 1,710 patients who underwent open TAA repair between 2003 and 2015. Patients were divided into a CR group (n = 419) and a non-CR group (n = 1,193). Follow-up duration was 1,603 (734-2,301) days in the CR group and 1,169 (610-1,991) days in the non-CR group. Propensity score matching was used to balance the baseline characteristics. Primary outcomes were MACE and all-cause mortality. RESULTS: After matching, the CR group exhibited a significantly lower incidence of MACEs (HR: 0.58; 95% CI: 0.34-0.97; P = 0.039) and all-cause mortality (HR: 0.59; 95% CI: 0.37-0.94; P = 0.026). The 5-year estimated all-cause mortality rate was 7.5% (95% CI: 4.9%-11.3%) and 12.3% (95% CI: 8.7%-17.3%), respectively. Cardiovascular deaths were 1.7% (7 of 419) and 2.9% (35 of 1,193) in the CR and non-CR groups, respectively (P = 0.17). Former smoking was independently associated with higher all-cause mortality (HR: 2.69; 95% CI: 1.62-4.45; P = 0.001). In former smokers, CR was associated with lower all-cause mortality (log-rank P = 0.008). CONCLUSIONS: Outpatient CR following TAA surgery was associated with reduced risks of MACE and all-cause mortality, even in the patients with former smoking.