Disclosures: Michael Chiou, MD: Nothing to disclose

Case Description: At baseline, the patient carried an extensive cardiac history of coronary artery disease, coronary artery bypass graft and aortic valve replacement, heart block requiring pacemaker, and atrial fibrillation. He was enrolled in a personalized inpatient brain injury rehabilitation program focused on improving purposeful movement, building endurance, and restoring speech. Throughout the rehabilitation course, he received aggressive intravenous antibiotic therapy and just prior to discharge from inpatient rehabilitation, after near-completion of his 6-week course of antibiotic therapy, an interval transesophageal echocardiogram revealed expanding aneurysm and persistent aortic valve vegetation.

Setting: Acute inpatient rehabilitation unit at a tertiary care hospital.

Patient: An 80-year-old male with prosthetic valve endocarditis, aortic root abscess, and left parieto-temporal ischemic stroke causing sudden-onset expressive aphasia and hemiparesis.

Assessment/Results: The patient was transferred to the cardiac unit and subsequently underwent reoperative sternotomy and aortic root replacement for root pseudoaneurysm and prosthetic valve endocarditis. As he had previously completed a course of prehabilitation, he avoided the need for further post-operative acute inpatient rehabilitation and was discharged to home after a short 2-week subacute stay.

Discussion: This patient presents a unique case of inpatient brain injury rehabilitation while concurrently optimizing a patient for a subsequent major cardiac operation – colloquially known as prehabilitation. Prehabilitation is conventionally described as the process of enhancing an individual’s functional capacity to enable them to withstand a forthcoming stressful event. Exercise rehabilitation enhances aerobic capacity to increase preoperative functional reserve to decrease post-operative morbidity and mortality. This case additionally highlights the benefits provided by hospital-based rehabilitation units where there is improved access to sub-specialty care and the ability to perform specialized procedures including invasive cardiac testing.

Conclusion: When presented with complicated patients who benefit from multi-specialty care, the role of hospital-based inpatient rehabilitation units at tertiary care hospitals should be recognized, especially for patients who may require subsequent operative intervention.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-most-vital-of-organs-a-case-of-stroke-and-cardiac-prehabilitation/