Abstract
Aim. The purpose of this study was to review the patient– and family-centered care studies in coronary artery bypass graft surgery.
Background. Nowadays, the length of hospital stay after cardiac surgery is reduced, and the most of the patients recover at home with their families without usual nursing and medical care. It is necessary to provide the care based on the same needs.
Methods. This is a comprehensive review of literature published between 1990-2018 about patient- and family-centered care interventions and patient/family important outcomes in adult ICUs that was conducted through searching out databases and search engines Medline, Ovid, Science Direct, PubMed and Google scholar, including English and Persian papers. In total, 73 English papers and 46 Persian papers were found, out of which 25 papers were included in this review.
Findings. Engaging families in patient care can profoundly influence clinical decision making and patient outcomes. Yet in many hospitals and health care systems, outdated visiting policies separate families and other loved ones during hospital stays.
Conclusion. Patient– and family-centered care is associated with better clinical outcomes. The clinical benefits that have been identified through a family partnership approach in these settings include decreased mortality, increased satisfaction, improved adherence to treatment regimens, and decreased readmission rates. Although high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in coronary artery bypass surgery, it is obvious this movement in healthcare is making a huge impact on family satisfaction and patient outcomes.

Abstract
Aim. This study was conducted to determine the effect of cognitive-behavioral rehabilitation based on stress immunization training on anxiety, stress and depression in patients with coronary artery bypass graft surgery.
Background. Stress, anxiety and depression that play an important role in coronary artery disorders, are being considered as a hindrance to recovery after CABG. Providing the patient with correct coping strategies with stress seems to be helpful in preventing the recurrence.
Method. The study was a quasi-experimental with control group with pretest-posttest design. The statistical population of this study included patients who had coronary artery bypass graft surgery and referred to the Rehabilitation center of Tehran Heart Hospital, Tehran, Iran. Thirty subjects were selected by continuous sampling method and randomly assigned into experimental and control group. The instruments for data collection were “Depression, Anxiety and Stress Scale” (DASS-21), which completed before and after the intervention. The experimental group was exposed to stress immunization training in 10 sessions of 90 minutes. To analyze the data, multivariate covariance analysis, and one-variable covariance analysis were used in SPSS software.
Findings. Stress immunization training significantly influenced the anxiety (p≤0.0001; F=0.39), stress (p≤0.0001; F=0.35), and depression (p≤0.0001; F=0.68) scores of the experimental group compared to the control group.
Conclusion. Stress immunization training plays an important role in reducing negative emotions (anxiety, stress and depression) in patients with coronary artery bypass graft surgery. It is recommended to use this intervention for patients undergoing CABG.

Abstract
Aim. The purpose of this study was to examine the effect of peer education on the anxiety - of post Coronary Artery Bypass Graft patients and caregivers
Background. Patients undergoing coronary artery bypass surgery experience moderate to high anxiety, which has also been reported among their family members. Studies have shown that educating patients and their family caregivers has in many cases reduced their anxiety. Peer education and research on the effect of peers is of great importance in promoting therapeutic and caring goals.
Method. This randomized clinical trial study was performed in year 2018 in surgery wards of Rajaee Cardiovascular Medical and Research center. In this study, 60 family caregivers of patients undergoing coronary artery bypass graft surgery and their respective patients were recruited at the time of discharge from intensive care unit and entering into the surgical ward. The subjects were randomly assigned to experimental and control group. Data collection tools included demographic information questionnaire and Spielberger's "State and trait anxiety" form. Initially, patients' family caregivers who were selected as peers were trained by the researcher in three stages. Before visiting the patients by family caregivers, their anxiety and also, patients' anxiety was measured in both groups. Thereafter, the patients’ family caregivers in the control group received routine training, and the patients' family caregivers in the experimental group received peer training in two sessions by their peers. In the third step, the anxiety of patients and their family caregivers in both groups were measured on the second and fifth days after intervention. The data were analyzed in SPSS 20 software.
Findings. Before intervention, the mean scores of anxiety in the experimental and control groups were not statistically different in both patients and their family caregivers, and the mean anxiety scores in both groups were moderate to high. After intervention, the mean score of anxiety in the experimental group was significantly lower than the control group (P≤0.0001). Also, in the second and fifth days after the intervention, there was a significant difference between the experimental and control groups in the mean score of anxiety of the patients and their family caregivers (P≤0.0001).
Conclusion. Peer education seems to reduce anxiety in patients and their family caregivers after discharge from ICU. It is suggested that peer education be used as effective and low cost education to reduce patient and family caregiver anxiety.

Abstract
Aim. This study aimed to examine the effect of open visiting hours on sleep quality, anxiety, and satisfaction of patients undergoing coronary artery bypass graft surgery (CABG).
Background. The importance of visiting patients after CABG has been emphasized in various studies, but there is insufficient evidence to confirm whether restricted /open visits may have more positive or negative effects than each other.
Method. In this clinical trial study, 60 post-CABG patients, admitted to Shahid Rajaei Cardiovascular, Medical and Research center, were randomly selected and divided into experimental (n=30) and control group (n=30). Patients in experimental group received an open visiting schedule (free visiting) and those in control group experienced a regular visiting schedule (restricted visiting). Anxiety was measured on the second and fourth days of hospitalization by the Spielberger Anxiety Inventory (STAI), sleep quality was measured by Richard Campbell and satisfaction was assessed through researcher-made questionnaire on the fourth day of hospitalization. Data were analyzed using independent t-test in SPSS-20 software.
Findings. There was a statistically significant difference between control and experimental groups in terms of anxiety mean score (43.97±6.76 against 35.90±4.31, respectively) (p≤0.0001). There was also a statistically significant difference between control and experimental groups in terms of mean score of patient satisfaction (46.13±7.15 vs 32.23±4.67, respectively) (p≤0.0001). A statistically significant difference was found between control and experimental groups in terms of sleep quality mean score (2.33±0.8 vs 3.33±0.75, respectively) (p≤0.0001).
Conclusion. Open visiting can reduces anxiety, and improves sleep quality and patients' satisfaction after CABG.

Abstract
Aim. This study aimed at examining the effect of preoperative fluid therapy on kidney function in patients undergoing heart surgery.
Background. As one of surgery complications, kidney failure occurs with oliguria and rise in creatinine. Decreased heart output leads to reduction in renal perfusion. Acute renal failure is associated with increase in morbidity, mortality and high medical treatment cost. Various studies has indicated an increase in postoperative mortality rate when complications of acute renal failure superimpose the situation. One of the best strategies for kidney protection is optimizing preoperative hemodynamics and fluid therapy.
Method. In this clinical trial study, 107 patients were recruited based on inclusion criteria and randomly allocated to experimental (n=54) and control (n=53) group. Patients in experimental group received Half- Saline, 1cc/kg/hr, during 12 hours before surgery. Patients in control group started as being NPO, 8 hours before the surgery. Creatinine level, BUN, and 24-hours urine output were measured and recorded during two days after surgery. Data were analyzed in SPSS V.22 using descriptive and inferential statistics.
Findings. The groups didn't differ in terms of age, gender, weight, and ejection fraction. There was no statistically significant difference between experimental and control group in terms of creatinine changes during the preoperative day and the first and the second day after surgery. Also, there was no statistically significant difference between groups in BUN on the first and second days after surgery. The urine output of the experimental group was greater than control group on first and second days after operation, but the difference was not significant. The duration of ICU stay were similar in both groups. There were recorded two deaths in control group while there was no death in experimental group.
Conclusion. It was concluded that preoperative fluid therapy has no short-term effect on kidney function. It is recommended to examine the effect of fluid therapy on kidney function in longer periods.

Abstract
Aim. The aim of this study was to evaluate the effect of cardiac rehabilitation training on patients' quality of life after coronary artery bypass grafting at Dr. Lavasani Hospital in Tehran.
Background. Coronary artery disease is the most common and serious chronic life-threatening disease. This disease affects many aspects of people's lives and reduces the quality of life. In many cases, coronary artery bypass graft surgery is needed to treat cardiac problems. Improving the quality of life is one of the important goals of participating in a cardiac rehabilitation program.
Method. In this one-group quasi-experimental study, 45 patients under coronary artery bypass graft surgery, hospitalized in Dr Lavasani Heart Hospital in Tehran, Iran, were selected by simple random sampling and were studied in a before-after design. Data collection tools included demographic questionnaire and Macnew Heart Disease Health-Related Quality of Life questionnaire. Cardiac rehabilitation training program was implemented in two sessions of 30 to 45 minutes with an interval of at least 24 hours at the time of hospitalization. Quality of life was measured in two stages, before the intervention and one month after the second training session. Data were analyzed in SPSS software version 25 using descriptive and inferential statistics.
Findings. The highest percentage of samples was male (57.8 percent), married (95.7 percent) and had primary education (47.8 percent). The mean age of women was 60.32±9.73 years, and the mean age of men was 60.50±12.60 years. After intervention, the mean quality of life score (128.71±4.95) increased significantly compared to the mean quality of life score before intervention (96.66±9.30) (p≤0.0001).
Conclusion. Cardiac rehabilitation in patients undergoing coronary artery bypass graft surgery can increase their quality of life. Nurses can play an important role in improving the quality of life of these patients through implementing cardiac rehabilitation training.

Abstract
Aim. The aim of this study was to examine the effect of protocol of weaning from mechanical ventilation on the gastrointestinal function in people undergoing CABG.
Background. The most common problems after cardiac surgery in the intensive care unit are change in vital signs, respiratory problems, unsuccessful separation from mechanical ventilation, and gastrointestinal problems. Due to the numerous effects that gastrointestinal problems have on the patient after cardiac surgery and also the economic burden that these complications impose on the patient and the health care system, choosing the best technique to prevent and control these problems is critical for the health care team.
Method. The present study was a randomized clinical trial conducted on 100 people undergoing CABG. They were allocated to control and experimental group based on permuted block randomization. The control group received routine way and experimental group received protocol of weaning. The groups  were compared in terms of nausea and vomiting, the time of beginning oral diet, defecation and bowel sounds before weaning 2, 6, and 12 hours after weaning from mechanical ventilation. Data were analyzed In SPSS version 23 using chi-square, Mann–Whitney U and Fisher tests.
Findings. In experimental group, there was a faster onset of bowel sounds and movements and earlier beginning of oral diet.
Conclusion. Patients who were under the protocol of weaning from mechanical ventilation had better gastrointestinal functional status compared to those who were under routine weaning.

Abstract
Aim. The aim of this literature review was to investigate the importance of adherence to diet in and nutritional recommendations for patient after coronary artery bypass graft surgery.
Background. Nutritional patterns after heart surgery are among the most important aspects of care that is provided by the nurse. Due to the importance of this issue, various studies have been conducted to focus on principles of proper nutrition after coronary artery bypass graft surgery and the necessary recommendations.
Method. The present review study was conducted through searching out databases and search engines Pub Med, SID, MagIran, Web of Sciences, Cochrane Library, CINHAL, OVID, Up-to-date, and Scopus without time limit using the keywords Coronary artery bypass graft surgery, Adherence to nutrition therapy, Cardiovascular disease, Survival rate, Complications of heart disease and nursing care, Diet, and Nutritional support. Out of a total of 103 articles, 65 articles with accessible full text entered the qualitative review stage, of which 51 articles entered the literature review.
Findings. The use of appropriate dietary approach such as consumption of fruits and vegetables, nuts and nuts, consumption of dairy products, fish and cooked and steamed foods should be the first priority of patients after coronary artery bypass graft surgery. They should avoid of fried and processed materials as much as possible.
Conclusion. Nurses' familiarity with the principles of nutrition and providing nutritional solutions, based on the latest guidelines published, to patients after coronary artery bypass graft surgery plays an important role in reducing complications and readmission of patients.

Abstract
Aim. The aim of this study was to review the effect of music as a non-invasive, non-pharmacological, inexpensive method with no side effects, on people with heart disease
Background. Heart disease is a common disease with considerable annual mortality. This review study investigates studies to bring a comprehensive view about the effect of music therapy on recovery of people with heart disease.
Method. This study was a narrative review in which studies in Persian and English language were searched out in databases/ search engines Magiran, SID, IranMedex, Pubmed, Scopus, and Google Scholar using the keywords music therapy, heart failure, acute coronary syndrome, hypertension, hypertension, heart surgery and open heart surgery. Inclusion criteria included articles being published in Persian or English language that examined the effect of music on recovery of people with heart disease. There was no time limit for articles under review. Exclusion criteria included articles that their full text were not accessible.
Findings. Out of 24 articles, the most of them (10 articles) examined the effect of music on hypertensive patients and on vital signs in heart patients (8 articles). The results showed that the effect of music on the recovery of heart patients included increasing the percentage of oxyhemoglobin saturation, relieving pain, reducing anxiety and depression, improving sleep quality and reducing fatigue. The music had no effect on mean arterial pressure and respiration. There were conflicting results regarding the effect of music on blood pressure and heart rate.
Conclusion. Considering the easy and cost-free application of this method, it is recommended that the health care team and especially nurses use this non-invasive method in the care of people with heart disease.

Abstract
Aim. This study was conducted to compare the effect of multidimensional spiritual therapy and stress inoculation training (SIT) on physiological and psychological coordination of heart rate variability (HRV) and depression in patients after coronary artery bypass graft (CABG) surgery.
Background. Depression and other emotional disorders play an important role in reducing the physiological and psychological coordination of heart rate in patients after coronary artery bypass graft (CABG) surgery. Depression and other emotional disorders prevent the person from recovering from the pathologic condition. It seems that preparing the patient for proper coping techniques is helpful in improving emotional disorders and preventing recurrence of disease.
Method. This was a clinical trial with two experimental and one control group. The study population included patients after CABG in Tehran Cardiac Research Center, Tehran, Iran. Thirty patients were randomly selected and assigned into three groups. The instrument of this study was the DASS-21 scale and the evaluation of physiological and psychological coordination of heart rate, which was measured before the intervention and at the end of the 10th session in groups. The first experimental group was exposed to the Meichenbaum stress inoculation training for 10 sessions of 90-minute duration, and the second experimental group received multidimensional spiritual therapy. Data were analyzed using Multivariate analysis of covariance in SPSS.
Findings. Multivariate analysis of covariance showed that SIT and multidimensional spiritual therapy interventions both have a statistically significant effect in reducing depression in one-month and three-month follow-up, compared to the control group, but their effects on reducing depression was significantly different (-2.200, P=0.002). However, no statistically significant difference was observed between experimental groups in terms of changes in physiological and psychological coordination (-0.00133, P=0.1).
Conclusion. SIT intervention seems to be less effective than multidimensional spiritual therapy in reducing depression, but its effect on changes in physiological and psychological coordination is the same as multidimensional spiritual therapy.

Abstract
Aim. This study was conducted to examine the effect of using Burn weaning checklist on the duration of mechanical ventilation and hemodynamic criteria in patients undergoing adult open heart surgery.
Background. Mechanical ventilation is an adjunct or alternative to spontaneous breathing. Due to the proximity of the circulatory and pulmonary systems, the balance of the mechanical ventilation system and the human cardiovascular system is complex, and its weaning must be planned.
Method. This randomized clinical trial study was performed on 80 patients admitted for open heart cardiopulmonary bypass surgery. After random assignment, in the control group, the weaning process was performed according to the routines by a physician, and in the experimental group, the weaning was performed by a Burn checklist by a physician and a nurse. Hemodynamic criteria (first and second hours upon arrival, first and second hours during weaning, first and second hours after weaning) and duration of mechanical ventilation were recorded and compared between experimental and control group. Data were analyzed in SPSS software version 22 using two-way repeated measures ANOVA.
Findings. The mean intubation duration in the experimental group (7.50±1.86 hours) was significantly less than the control group (11.30±3.39 hours) (P≤0.0001). The interaction between group and time for variables diastolic blood pressure (P=0.002), pulse pressure (P=0.003) and heart rate (P≤0.0001) was statistically significant.
Conclusion. The use of the Burn assessment checklist reduces the duration of weaning process in patients after adult open heart surgery. It also helps balancing hemodynamic criteria.

Abstract
Aim. This Study aimed to examine the effect of social networking education on blood glucose control and post-surgical infections after open heart surgery in diabetic patients.
Background. Cardiovascular surgery is one of the most common surgeries that is performed with the aim of increasing survival and improving the quality of life in diabetic patients.
Method. This randomized clinical trial study was conducted on 120 diabetic patients (age range 18-60 years) who underwent open heart surgery at Shahid Rajaei Cardiovascular Research and Research Center. The participants were randomly divided into experimental (n=60) and control group (n=60). In the experimental group, posts were delivered to patients with educational content (such as nutrition education, blood sugar self-monitoring, and ...) on a daily basis for three months on the WhatsApp social network. Data were collected by a checklist consisting of three parts: demographic characteristics, fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c) of patients before and 3 months after the intervention.
Findings. In both experimental and control group, 55 percent were male and 45percent were female. The percent of patients with postoperative wound infection in the experimental and control groups was 5.0 and 3.3, respectively. After intervention, in the experimental group, the FBS and Hb1Ac median was significantly reduced compared to before the intervention (p<0.001). The levels of FBS and Hb1Ac before and after the intervention did not differ significantly between the experimental and control group.
Conclusion. There was no different between groups in terms of blood sugar control and wound infections after open heart surgery. Due to the easy access, lack of time and space limitations of using social networks, further studies with longer follow-up are recommended.

Abstract
Aim. The aim of this study was to examine the effect of cognitive-behavioral therapy on depression, anxiety, and stress in patients after coronary artery bypass graft surgery.
Background. Coronary artery bypass graft surgery, like other surgeries, is stressful for the patient, and depression, anxiety, and stress are common important disorders in these patients. In this regard, one of the effective psychotherapy methods to reduce negative psychological factors and prevent recurrence of the disease is cognitive-behavioral therapy.
Method. The design of the present study was quasi-experimental with a pretest-posttest design with a control group. The statistical population of the study included all patients after coronary artery bypass graft surgery in selected AJA hospital in Tehran, Iran. Based on convenience sampling, 30 people were selected and randomly allocated to experimental (n=15) and control (n=15) group. They responded to the Depression, Anxiety and Stress Questionnaire (DASS-21) and underwent 15 sessions of psychotherapy. The experimental and control group were homogeneous in terms of age, education, as well as duration of hospital stay and absence of other chronic diseases. The univariate analysis of covariance was performed using SPSS-23.
Findings. The results showed that depression, anxiety and stress of the experimental group significantly reduced in the post-test compared to those of control group.
Conclusion. In addition to medical interventions, cognitive-behavioral therapy can also be used for patients after coronary artery bypass graft surgery to reduce depression, anxiety and stress and prevent recurrence of the disease. Special attention can also be paid to the psychological factors that cause or exacerbate cardiovascular disease.

Abstract
Aim. The aim of this study was to design and examine the psychometrics of post-traumatic stress disorder tool for children undergoing heart surgery
Background. Heart disease is one of the most important health issues and traumatic events that cause great harm to children, one of which is the experience of surgery. Therefore, we need a standard tool to assess post-traumatic stress disorder in children.
Method. In this methodological study, researchers compiled a questionnaire for measuring post-traumatic stress disorder in children undergoing heart surgery. The questionnaire was provided to 10 experts to examine the validity. In the next step, 40 items, revised by experts, were examined for construct validity and reliability based on the responses of 200 children 12-18 years old to questionnaire. The data were analyzed in SPSS version 24 and LISREL version 10.
Findings. After preparing the draft, the questionnaire was given to 10 experts to determine face and content validity. For face validity, the impact score of the items was computed and due to similar meaning of some items they were merged. In order to determine the content validity, two indexes of content validity ratio (CVR) and content validity index (CVI) were considered. According to Lauche's table, items with a content validity ratio less than 0.62 were excluded (7 items), items with a content validity ratio greater than 0.79 were accepted, and items with a content validity ratio between 0.70 and 0.79 were revised. In the construct validity stage, to ensure the sufficient sample size, the Kaiser-Meier-Elkin (KMO) test was performed and the results of Bartlett's Sphericity test were significant (P≤0.0001). Finally, exploratory factor analysis was performed with Varimax rotation on 40 items, and 7 items with a factor loading of less than 0.4 were removed, and in the end, 33 items remained. To determine the reliability of the questionnaire using the internal consistency method, Cronbach's alpha of the questions were computed and it was above 0.80 for all items. The test-retest results confirmed the significant relationship between the pre-test and post-test scores in 7 factors of the questionnaire (P≤0.0001).
Conclusion. In order to achieve more accurate results in research, it is necessary to use valid and reliable tools. The results of this study showed the strength of the factor structure and acceptable reliability of the post-traumatic stress tool for children undergoing heart surgery. The tool designed in this study is valid and reliable and can be used to determine post-traumatic stress in children undergoing heart surgery.

ABSTRACT
Aim. The aim of the present study was to examine the effect of early mobilization protocol on the strength of diaphragmatic muscle and other inspiratory muscles after open heart surgery.
Background. Early mobilization is recommended as a safe protocol after open heart surgery to decrease hospital stay and post-op respiratory complications; however, our knowledge about its effect on improving respiratory muscles strength is limited.
Methods. This is a randomized single-blinded clinical trial conducted on 80 consecutive patients who underwent coronary artery bypass surgery and/or valvular surgery that were randomly assigned to experimental group (postoperative early mobilization) and control group (routine physiotherapy). On the day before surgery and the day before leaving intensive care unit (ICU), two scores were measured for assessing diaphragmatic muscle strength: maximum inspiratory pressure (PI max) and Strength index (S index). Hemodynamic parameters were also measured and compared.
Findings. According to both PI max and S index, diaphragmatic muscle strength decreased from 77.28 to 59.53 cmH₂O in patients after surgery, but the changes in the experimental group was less than the control group, which indicates a significant improvement in the strength of the diaphragm muscle in the experimental group (p≤0.0001). Hemodynamic changes after surgery (lower blood pressure and increased heart rate) occurred in both groups without any significant clinical effect.
Conclusion. Early mobilization after cardiac surgery has positive effect on the strength of diaphragmatic muscle and is also safe as shown to have no adverse effect on hemodynamic parameters.

Abstract:
Aim. The aim of this article is to review studies that have evaluated effective interventions in the prevention of mediastinitis following cardiothoracic surgery.
Background. Mediastinitis and deep surgical wound infections (DSWI) are life-threatening complications of median sternotomy and have a prevalence of 0.4-5 percent. They can produce a significant financial burden on the patient and also the health care system by prolonging the hospitalization period and the need for repeated surgeries or long-term antibiotics. Several risk factors have been identified for mediastinitis following cardiothoracic surgery, many of which are easily preventable by proper diagnosis.
Method. In this literature review, databases including PubMed, Medline, UpToDate, Scopus, Science
Direct, SID, and Magiran were searched out using the keywords Mediastinitis, Prevention, Cardiothoracic
surgery, and their Persian equivalents. Persian and English original articles (including cross-sectional, case- control, cohort studies, and clinical trials) investigating the effective interventions in the prevention of me- diastinitis following cardiothoracic surgeries and were published between 2000 and 2021 and had an available full text, were included in the current study; review articles, letter to editors, and case reports published in non-authoritative journals were excluded from this study. After primary search, 62 relevant articles were found and based on inclusion/exclusion criteria, 16 articles were finally selected and reviewed in the cur- rent study.
Findings. Mediastinitis ca n be prevented before surgery by hand hygiene, weight loss, smoking cessa-tion, proper prophylactic antibiotics, decolonization of nasopharynx and oropharynx from Staph aureus by Mupirocin ointment, and removing hair using depilatory cream (not the blade). Tight blood glucose monitoring before, after, and during the surgery, disinfection of the surgical field by chlorhexidine, using a proper surgical technique for wound closure and stabilizing the sternum, and proper patient training by nurses about red flags of infection can play an important role in the prevention of mediastinitis.
Conclusion. Mediastinitis ca n be easily prevented by identifying its risk factors and controlling them accurately and in a timely manner.

Abstract
Aim. This review study was conducted with the aim of highlighting the importance of a preoperative preventive approach in the recovery of patients undergoing coronary artery bypass surgery.
Background. With the increase in the number of patients who are candidated for heart surgery, improving the health status before the operation is of great importance to optimize the results after the operation. This review has been conducted with the aim of evaluating the evidence related to the pre-rehabilitation of patients undergoing coronary artery bypass surgery.
Method. The present literature review was conducted by searching out library resources and databases, Scopus, Chochrane Library, Magiran, SID, PubMed, Up-to-date, OVID, CINAHL, and Web of Science with the keywords, coronary artery bypass surgery, pre-rehabilitation, cardiovascular disease and their Persian equivalents without time limit. From a total of 104 articles, 63 full texts articles entered the review stage, of which 17 articles entered the literature review.
Findings. The findings indicate the favorable effects of pre-rehabilitation on improving the quality of life and preventing complications in the early postoperative period. Pre-rehabilitation programs should adopt multifaceted approaches including nutrition, exercise, and anxiety reduction to improve patient resilience in the preoperative period. The pre-operative period is a critical opportunity to implement pre-rehabilitation interventions for vulnerable patients awaiting cardiac surgery.
Conclusion. Cardiac pre-rehabilitation includes a wide range of preventive interventions that can be taught by nurses to patients undergoing cardiac surgery. Pre-rehabilitation requires an interdisciplinary approach, because it suggests a change from the current model of health care and transformation from one-dimensional care to interdisciplinary care, which can be an effective tool for the medical and nursing system in timely identification of physical and mental disorders in initial preoperative assessment, preoperative education and management, as well as prevention of postoperative complications.

Abstract
Aim. This study aimed to compare the effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on consequence of weaning off patients from mechanical ventilator after coronary artery bypass surgery
Background. The ventilation mode used for respiratory support in patients after coronary artery bypass graft surgery is very important. In addition to avoiding pressure on patient's sternotomy incision, the ventilation mode should also provide the possibility of rapid weaning of patient to avoid complications caused by long-term ventilation.
Method. In a semi-experimental study, 26 patients were ventilated with ASV as the experimental group and 26 patients were ventilated with SIMV-PS mode as the control group after coronary artery bypass graft surgery in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Mechanical ventilation time and endotracheal tube removal time, hemodynamic variables, and arterial blood gas analysis were compared between the two groups. Data were analyzed using an independent t-test, repeated measures ANOVA and chi-square.
Findings. Out of 52 patients, 36 (69.2 percent) were male and 16 (30.8 percent) were female. The mean time for the endotracheal tube removal was 89.42±33.83 minutes in the experimental group and 101.53±44.91 minutes in control group, which did not have a statistically significant difference (p=0.843). The mean duration of mechanical ventilation of patients in the experimental group was 483.84±158.153 minutes and in the control group, it was 541.92±257.81 minutes, which were not statistically different (p=0.332).
Conclusion. The use of ASV mode for mechanical ventilation after coronary artery bypass graft did not affect reducing the duration of mechanical ventilation and the time of endotracheal tube removal compared to SIMV-PS mode. Therefore, the use of ASV mode for respiratory support of patients undergoing coronary artery bypass surgery should be considered according to the patient's condition and the nurses' expertise.