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.