Cardiac rehabilitation programme after transcatheter aortic valve implantation versus surgical aortic valve replacement: Systematic review and meta-analysis

Abstract

Background Aortic stenosis is a valvular heart disease characterised by fixed obstruction of the left ventricular outflow. It can be managed by surgical aortic valve replacement (sAVR) or transcatheter aortic valve implantation (TAVI). This review aimed to describe the evidence supporting a cardiac rehabilitation programme on functional capacity and quality of life in aortic stenosis patients after sAVR or TAVI. Methods The search was conducted on multiple databases from January to March 2016. All studies were eligible that evaluated the effects of a post-interventional cardiac rehabilitation programme in aortic stenosis patients. The methodological quality was assessed using the PEDro scale. Meta-analysis was performed separately by procedure and between procedures. The walked distance during the six-minute walk test (6MWD) and Barthel index were evaluated. The analysis was conducted in Review Manager. Results Five studies were included (292 TAVI and 570 sAVR patients). The meta-analysis showed that a cardiac rehabilitation programme was associated with a significant improvement in 6MWD (0.69 (0.47, 0.91); P < 0.001) and Barthel index (0.80 (0.29, 1.30); P = 0.002) after TAVI and 6MWD (0.79 (0.43, 1.15); P < 0.001) and Barthel index (0.93 (0.67, 1.18); P < 0.001) after sAVR. In addition, the meta-analysis showed that the cardiac rehabilitation programme promoted a similar gain in 6MWD (4.28% (-12.73, 21.29); P = 0.62) and Barthel index (-1.52 points (-4.81, 1.76); P = 0.36) after sAVR or TAVI. Conclusions The cardiac rehabilitation programme improved the functional capacity and quality of life in aortic stenosis patients. Patients who underwent TAVI benefitted with a cardiac rehabilitation programme similar to sAVR patients.

Geriatric or cardiac rehabilitation? Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation

“…Consequently, multimorbid octogenarians with functional limitations become more present in cardiac rehabilitation (CR), whereby hospitals have to define the decision making process for the subsequent treatment and rehabilitation centers have to focus the therapy offer on the patients' individual demands such as improving postural control and combating malnutrition. After TAVI, cardiac rehabilitation already leads to significant improvements in exercise tolerance, walking capacity, muscle strength and quality of life [5][6][7][8][9]. Thus, official position statements promote the implementation of cardiac rehabilitation after TAVI, although there are no specific therapies yet for the individual needs of this old patient group [10,11].…”

Transforming the experience of aortic valve disease in older patients: A qualitative study

“…As a result, there was no clear picture of the need for rehabilitation or of the rehabilitation services in Denmark. Studies report that cardiac rehabilitation after TAVI can improve physical fitness and QoL (Eichler et al, ; Ribeiro et al, ). The question can be raised as to whether all patients who underwent treatment have the resources to make the effort needed to return to a satisfying life.…”

The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function

“…Current CR guidelines remain, however, to be optimized for patients receiving heart valve surgery due to a lack of data (Piepoli et al., ). As a result of a deterioration in pulmonary and skeletal muscle function, a multidisciplinary rehabilitation intervention with endurance exercise training can lead to improvements in quality of life, functional capacity and exercise tolerance after mini‐AVR (Ribeiro et al., ). However, from our experience, we believe that CR will be more successful if inspiratory muscle training is performed as soon as possible after mini‐AVR.…”