Rehabilitation program
Our rehabilitation program began on day 1 postoperatively. Range of motion exercise and respiratory rehabilitation were performed on the bed during intubation on day 1. After extubation, patients with hoarseness and dysphagia proactively underwent speech and swallowing therapy. Physical rehabilitation was carried out in a seated position on the bed and included foot stepping, standing by the bedside, and walking 50 m. Afterward, walking distance was gradually increased from 100 to 200 m, depending on the patient’s condition. Patients who walked at discharge were confirmed to be able to walk >200 m before discharge. Patients who were unable to walk postoperatively due to paraplegia or major cerebral infarction did not participate in the rehabilitation program. Systolic and diastolic blood pressure (dBP) levels were monitored before and after rehabilitation. According to the guidelines for rehabilitation in patients with cardiovascular disease,10 patients with communicating and noncommunicating aortic dissection after surgery had sBP level maintained at ≤120 mmHg and ≤130 mmHg, respectively, during rehabilitation with antihypertensive drugs including calcium blockers, angiotensin II receptor blockers (ARBs), angiotensin-converting-enzyme (ACE) inhibitors, or beta blockers. Postoperative computed tomography angiography was performed within 7 days to assess whether the false lumen of descending aorta or below was thrombosed or not. During rehabilitation, patients who presented with leg fatigue, dyspnea, or who were evaluated by physical therapists to be at risk of falling were discontinued from walking. We followed the discontinuance criteria of the rehabilitation described in the guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012).10.