Perioperative Inspiratory Muscle Training Improves Functional Recovery in Heart Valve Replacement: A Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: Heart valve replacement is associated with a high risk of respiratory dysfunction and postoperative pulmonary complications (PPCs). This meta-analysis of randomised controlled trials (RCTs) specifically aims to evaluate the effectiveness of perioperative inspiratory muscle training (IMT) in this patient population. METHODS: A systematic search was conducted on ClinicalTrials.gov, PubMed, ProQuest, and Scopus until October 2025. Data were synthesised using random-effects meta-analysis, with results reported as mean difference (MD), standardised mean difference (SMD), or risk ratio (RR), along with 95% confidence intervals (CI). RESULTS: A total of nine RCTs involving 1531 patients were included. IMT significantly improved primary outcomes: 6-min walk distance (6 MWD) (MD 49.91 m; 95% CI, 22.52-77.30), maximal inspiratory pressure (MIP) (MD 11.66 cm H2O; 95% CI, 3.15-20.16), and reduced the incidence of PPCs (RR 0.71; 95% CI, 0.56-0.90) 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 s (FEV1), 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. CONCLUSIONS: 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).