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J Cardiovasc Med (Hagerstown). 2017 Feb;18(2):114-120. doi: 10.2459/JCM.0000000000000494.

Cardiac rehabilitation after transcatheter aortic valve implantation compared to patients after valve replacement.

Author information

1
aDivision of Cardiology, Fondazione Salvatore Maugeri, Presidio Major, Torino bService of Bioengineering cDivision of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy.

Abstract

AIMS:

To evaluate feasibility, safety, and outcome of an exercise-based residential cardiac rehabilitation program in transcatheter aortic valve implantation (TAVI) patients compared to elderly patients after surgical valve replacement (sAVR).

METHODS:

From January 2010 to January 2013, 65 consecutive TAVI and 70 sAVR older than 70 years were enrolled. Six-min walk test (6MWT) distance, Barthel index, Morse Fall Scale (MFS) on admission and discharge, Cumulative Illness Rated State-Comorbidity Index (CIRS-CI), and echocardiography were assessed. Patients underwent a 3-week intensive cardiac rehabilitation program.

RESULTS:

Compared with sAVR, TAVI had worse CIRS-CI (4.8 ± 1.5 vs. 3.4 ± 1.5; P = 0.00001), left ventricle ejection fraction (55.3 ± 9 vs. 59.2 ± 7.7; P = 0.008), Barthel index (67 ± 24 vs. 79 ± 21; P = 0.0018), and MFS (36 ± 22 vs. 25 ± 19; P = 0.002) on admission and at discharge (Barthel index 85 ± 17 vs. 93 ± 14; P = 0.005 and MFS 30 ± 20 vs. 20 ± 12; P = 0.0001), despite a significant improvement at discharge of Barthel index (85 ± 17 vs. 67 ± 24; P = 0.001) and MFS (36 ± 22 vs. 30 ± 20; P > 0.01). TAVI attended safely cardiac rehabilitation, but tolerated a significantly lower workload and had reduced 6MWT both on admission and discharge compared with sAVR (162 ± 87vs. 216 ± 82; P = 0.00001, and 240 ± 92 vs. 33295; P = 0.00001, respectively), despite a net improvement at discharge in 6MWT (240 ± 92 vs. 162 ± 92; P < 0.001).

CONCLUSION:

Intensive cardiac rehabilitation after TAVI is safe, well tolerated, and leads to a net improvement in disability, risk of falls, and exercise capacity, similar to that observed in less disabled sAVR patients, favoring home discharge and relatively independent life at home. A persistent higher disability, comorbidity profile, and risk of falls at discharge characterize TAVI patients compared with sAVR patients of similar age.

PMID:
27941588
DOI:
10.2459/JCM.0000000000000494
[Indexed for MEDLINE]

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