Prehabilitation in Cardiac Surgery: Part 1: From Phenotype-driven Risk Stratification to Individualized Multimodal Preoperative Optimization.

Cardiac surgery patients increasingly present with frailty, sarcopenia, malnutrition, anemia, and psychological distress, contributing to high perioperative risk and impaired recovery. Prehabilitation has emerged within Enhanced Recovery after Surgery cardiac frameworks as a proactive strategy to enhance physiologic and psychological resilience before surgery. This article summarizes current evidence on risk stratification and the core components of multimodal prehabilitation, including nutrition, exercise, patient blood management, and psychological support. Emphasis is placed on phenotype-driven patient selection and intervention tailoring, as well as practical considerations and future directions for integrating prehabilitation into routine cardiac surgical care.