Physical Recovery and Health-Related Quality of Life Outcomes Following Cardiac Surgery: A Systematic Review

Background Cardiac surgery is the cornerstone of therapy for advanced coronary, aortic, and valvular heart disease. As survival improves, outcomes now include physical recovery and health-related quality of life (HRQoL). While a synthesis linking recovery metrics with HRQoL remains lacking, this systematic review aims to characterize recovery trajectories and their determinants across diverse surgical populations and approaches. Methods We conducted a systematic review of PubMed, Embase, and Cochrane Library through December 31, 2025. Eligible studies included adults undergoing coronary artery bypass grafting (CABG), surgical valve repair or replacement, or aortic root procedures reporting quantitative recovery endpoints or validated HRQoL measures. Transcatheter-only procedures were excluded unless directly compared with surgical cohorts. Two reviewers independently screened and extracted data using Covidence per PRISMA guidelines. Results Of 1,499 records, 25 studies were included (n=32,322). Cardiac surgery consistently produced substantial improvements in HRQoL and physical recovery, with postoperative scores converging toward age-matched norms by 6-12 months regardless of procedure type. Minimally invasive techniques generally reduced ICU and hospital stays, though randomized trial findings were inconsistent. Postoperative complications, particularly atrial fibrillation and renal failure, were linked to impaired long-term recovery. Improvements were strongly associated with baseline functional status and cardiac rehabilitation participation. Conclusion Physical recovery and HRQoL after cardiac surgery are influenced by surgical technique and patient factors. Although minimally invasive approaches often enable faster short-term recovery, long-term HRQoL appears comparable across procedures. Preventing postoperative complications is a key modifiable determinant. Standardized recovery metrics and validated HRQoL instruments are essential to advance patient-centered cardiac care.