ANZ journal of surgery · 2026
Perioperative Inspiratory Muscle Training Improves Functional Recovery in Heart Valve Replacement: A Meta-Analysis of Randomised Controlled Trials.
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Tjahjono Cholid Tri, Mayangsari Veny, Rayyan Muhammad Isra Rafidin, Larasati Sabila, Rahman Fadhlan Abdur, Rizqa Siti Ulfatur, Hasya Aghnia, Ramadhitya Alvian, Mata Lusi Padma Sulistianingsih, Asfa Adelia Fairus Wafi, Saputra Pandit Bagus Tri
Аннотация
BACKGROUND: Heart valve replacement is associated with a high risk of respiratory dysfunction and postoperative pulmonary complications (PPCs). This meta-analysis of randomised controlled trials (RCTs) specifically aims to evaluate the effectiveness of perioperative inspiratory muscle training (IMT) in this patient population.
METHODS: A systematic search was conducted on ClinicalTrials.gov, PubMed, ProQuest, and Scopus until October 2025. Data were synthesised using random-effects meta-analysis, with results reported as mean difference (MD), standardised mean difference (SMD), or risk ratio (RR), along with 95% confidence intervals (CI).
RESULTS: A total of nine RCTs involving 1531 patients were included. IMT significantly improved primary outcomes: 6-min walk distance (6 MWD) (MD 49.91 m; 95% CI, 22.52-77.30), maximal inspiratory pressure (MIP) (MD 11.66 cm H2O; 95% CI, 3.15-20.16), and reduced the incidence of PPCs (RR 0.71; 95% CI, 0.56-0.90) compared to the control group. However, for secondary outcomes, including ICU and postoperative length of stay (LOS), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1), no significant differences were observed. Subgroup analysis indicated greater clinical benefits of IMT in patients undergoing open surgery who received it postoperatively and integrated it into a rehabilitation bundle.
CONCLUSIONS: IMT may improve 6 MWD and MIP and reduce the risk of PPCs in patients undergoing valve replacement. These findings suggest that IMT is a promising adjunct to perioperative cardiac rehabilitation (PROSPERO CRD420251172698).
METHODS: A systematic search was conducted on ClinicalTrials.gov, PubMed, ProQuest, and Scopus until October 2025. Data were synthesised using random-effects meta-analysis, with results reported as mean difference (MD), standardised mean difference (SMD), or risk ratio (RR), along with 95% confidence intervals (CI).
RESULTS: A total of nine RCTs involving 1531 patients were included. IMT significantly improved primary outcomes: 6-min walk distance (6 MWD) (MD 49.91 m; 95% CI, 22.52-77.30), maximal inspiratory pressure (MIP) (MD 11.66 cm H2O; 95% CI, 3.15-20.16), and reduced the incidence of PPCs (RR 0.71; 95% CI, 0.56-0.90) compared to the control group. However, for secondary outcomes, including ICU and postoperative length of stay (LOS), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1), no significant differences were observed. Subgroup analysis indicated greater clinical benefits of IMT in patients undergoing open surgery who received it postoperatively and integrated it into a rehabilitation bundle.
CONCLUSIONS: IMT may improve 6 MWD and MIP and reduce the risk of PPCs in patients undergoing valve replacement. These findings suggest that IMT is a promising adjunct to perioperative cardiac rehabilitation (PROSPERO CRD420251172698).