Safety of exercise after pulmonary endarterectomy: a systematic review.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism, leading to high pulmonary arterial pressures. Pulmonary endarterectomy (PEA) surgery is the gold standard treatment for CTEPH, significantly improving patient outcomes. Post-operative cardiac remodelling is an important consideration, highlighting the need to balance early exercise with potential impacts on cardiac recovery. The objective of the present study was to investigate the safety and feasibility of early exercise interventions following PEA surgery for CTEPH, and to review the existing literature on early exercise interventions post-PEA. Methods: A systematic review was conducted using the AMED, CINAHL, Embase and MEDLINE databases. Search terms included "pulmonary endarterectomy", "chronic thromboembolic pulmonary hypertension", "exercise", "exercise training", "mobility" and "rehabilitation". Studies were included if they involved adult patients with CTEPH who underwent PEA and participated in post-operative exercise interventions. Results: The review identified studies with small, heterogeneous patient cohorts engaging in early post-operative exercise following PEA. Interventions included walking, cycling, dumbbell exercises and respiratory training. Safety measures, such as continuous monitoring of oxygen levels and heart rate, were implemented and no adverse events were reported. Improvements in exercise capacity and right heart measurements were observed, suggesting that early exercise is both safe and beneficial. Conclusion: Early exercise interventions following PEA surgery appear safe and feasible, with potential benefits for exercise capacity and cardiac remodelling. Future research should include randomised controlled trials and qualitative studies to confirm these findings and assess impacts on patient quality of life.