{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:08:30Z","timestamp":1788847710349,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart valve replacement is associated with a high risk of respiratory dysfunction and postoperative pulmonary complications (PPCs). This meta\u2010analysis of randomised controlled trials (RCTs) specifically aims to evaluate the effectiveness of perioperative inspiratory muscle training (IMT) in this patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic search was conducted on\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , PubMed, ProQuest, and Scopus until October 2025. Data were synthesised using random\u2010effects meta\u2010analysis, with results reported as mean difference (MD), standardised mean difference (SMD), or risk ratio (RR), along with 95% confidence intervals (CI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of nine RCTs involving 1531 patients were included. IMT significantly improved primary outcomes: 6\u2010min walk distance (6 MWD) (MD 49.91\u2009m; 95% CI, 22.52\u201377.30), maximal inspiratory pressure (MIP) (MD 11.66 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O; 95% CI, 3.15\u201320.16), and reduced the incidence of PPCs (RR 0.71; 95% CI, 0.56\u20130.90) compared to the control group. However, for secondary outcomes, including ICU and postoperative length of stay (LOS), forced vital capacity (FVC), and forced expiratory volume in 1\u2009s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      ), no significant differences were observed. Subgroup analysis indicated greater clinical benefits of IMT in patients undergoing open surgery who received it postoperatively and integrated it into a rehabilitation bundle.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>IMT may improve 6 MWD and MIP and reduce the risk of PPCs in patients undergoing valve replacement. These findings suggest that IMT is a promising adjunct to perioperative cardiac rehabilitation (PROSPERO CRD420251172698).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70938","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:51:03Z","timestamp":1788846663000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Inspiratory Muscle Training Improves Functional Recovery in Heart Valve Replacement: A Meta\u2010Analysis of Randomised Controlled Trials"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6766-2792","authenticated-orcid":false,"given":"Cholid Tri","family":"Tjahjono","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Prevention and Rehabilitation, Department of Cardiology and Vascular Medicine Universitas Brawijaya \u2013 Dr. Saiful Anwar General Academic Hospital  Malang 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Medicine, Universitas Jember  Jember Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadhlan Abdur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Jember  Jember Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti Ulfatur","family":"Rizqa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Jember  Jember Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aghnia","family":"Hasya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Jember  Jember Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvian","family":"Ramadhitya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Jember  Jember Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lusi Padma 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