Intervenção fisioterapêutica em pacientes submetidos ao transplante cardíaco no pós-operatório precoce: revisão sistemática de estudos clínicos e ensaios

Abstract

Introduction: Heart transplantation represents the definitive treatment for advanced heart failure refractory to pharmacological management. In the early postoperative period (inpatient Phase I), physiological changes resulting from autonomic denervation of the graft, combined with the impacts of sternotomy and prolonged bed rest, impair functional capacity and increase cardiorespiratory risks. Objective: To map and analyze the physiotherapeutic interventions applied during the first phase of the early postoperative period in heart transplant recipients, based exclusively on evidence from clinical trials, direct intervention studies, and clinical case reports. Method: Systematic review of clinical studies conducted in MEDLINE (PubMed), LILACS, SciELO, and PEDro databases from 2020 to 2026. The PICo strategy was used to formulate the guiding question. Only controlled clinical trials, interventional cohort studies, case series, and clinical case reports were included. All narrative, integrative, or systematic literature reviews were excluded. Results: The final sample consisted of 5 primary clinical studies (direct intervention trials and case reports). Phase I management included: respiratory physiotherapy (lung re-expansion, bronchial hygiene, sternal-supported coughing, incentive spirometry, and positive pressure support); early mobilization (active and passive limb kinesiotherapy); functional progression (edge-of-bed sitting, standing, transfers); bedside cycle ergometry; and progressive ambulation and stair training. Conclusion: Physiotherapeutic intervention during Phase I is feasible, safe, and effective. It promotes muscle strength recovery, optimizes lung volumes, reduces mechanical ventilation and ICU length of stay, and improves functional autonomy without recording severe hemodynamic adverse events.