Cardiac rehabilitation outcome after transcatheter aortic valve implantation
Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR). Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI.
Perera S, Wijesinghe N, Ly E, et al. Outcome of patients with untreated severe aortic stenosis in real-world practice. N Zeal Med J 2011;124:40-8.
Strange G, Stewart S, Celermajer D, et al. Poor long-term survival in patients with moderate aortic stenosis. J Am Coll Cardiol 2019;74:1851-63. DOI: https://doi.org/10.1016/j.jacc.2019.08.004
Cribier AG. The odyssey of TAVR from concept to clinical reality. Tex Heart Inst J 2014;41:125-30. DOI: https://doi.org/10.14503/THIJ-14-4137
Rostagno C. Heart valve disease in elderly. World J Cardiol 2019;11:71-83. DOI: https://doi.org/10.4330/wjc.v11.i2.71
Randall MH, Bavry AA. Update on transcatheter aortic valve replacement. Cardiol Ther 2020;9:75-84. DOI: https://doi.org/10.1007/s40119-020-00167-6
Liu Z, Kidney E, Bem D, et al. Transcatheter aortic valve implantation for aortic stenosis in high surgical risk patients: a systematic review and meta-analysis. PLoS One 2018;13:e0196877. DOI: https://doi.org/10.1371/journal.pone.0196877
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135:e1159-95.
Haude M. [Management of valvular heart disease: ESC/EACTS guidelines 2017].[Article in German]. Herz 2017;42:715-20. DOI: https://doi.org/10.1007/s00059-017-4643-5
Epstein E, Rosander A, Pazargadi A, et al. Cardiac rehab for functional improvement. Curr Heart Fail Rep 2020;17:161-70. DOI: https://doi.org/10.1007/s11897-020-00462-2
Thomas RJ, Balady G, Banka G, et al. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A report of the American College of Cardiology/American Heart Association Task Force on performance measures. Am Coll Cardiol 2018;71:1814-37. DOI: https://doi.org/10.1016/j.jacc.2018.01.004
Ribeiro GS, Melo RD, Deresz LF, et al. Cardiac Rehabilitation programme after transcatheter aortic valve implantation versus surgical aortic valve replacement: systematic review and meta-analysis. Eur J Prev Cardiol 2017;24:688-97. DOI: https://doi.org/10.1177/2047487316686442
Anayo L, Rogers P, Long L, et al. Exercise-based cardiac rehabilitation for patients following open surgical aortic valve replacement and transcatheter aortic valve implant: a systematic review and meta-analysis. Open Heart 2019;6:e000922.
Mahoney FI, Bartel DW. Functional evaluation: the Barthel index. Md State Med J 1965;14:61-5.
Guralnik, JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85-94. DOI: https://doi.org/10.1093/geronj/49.2.M85
Enright PL, McBurnie MA, Bittner V, et al. The 6-min walk test: A quick measure of functional status in elderly adults. Chest 2003;123:387-98. DOI: https://doi.org/10.1378/chest.123.2.387
Carnero-Alcazar, Maloto LM, Cobiella-Carnicer J, et al. Transcatheter versus surgical aortic valve replacement in moderate and high-risk patients: a meta-analysis. Eur Cardiothorac Surg 2017;51:644-52.
Panoulas VF, Francis DP, Ruparelia N, et al. Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: meta-analysis of the gender subgroups of randomized controlled trials including 3718 patients. Int J Cardio. 2018;250:66-72. DOI: https://doi.org/10.1016/j.ijcard.2017.05.047
Eichler S, Salzwedel A, Reibis R, et al. Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: Predictors of functional and psychocognitive recovery. Eur J Prev Cardiol 2017;24:257-64. DOI: https://doi.org/10.1177/2047487316679527
Tarro Genta F, Tidu M, Bouslenko Z, et al. Cardiac rehabilitation after transcatheter aortic valve implantation compared to patients after valve replacement. J Cardiovasc Med (Hagerstown). 2017;18:114-20. DOI: https://doi.org/10.2459/JCM.0000000000000494
Molino-Lova R, Pasquini G, Vannetti F, et al. Effects of a structured physical activity intervention on measures of physical performance in frail elderly patients after cardiac rehabilitation: a pilot study with 1-year follow-up. Intern Emerg Med 2013;8:581-9. DOI: https://doi.org/10.1007/s11739-011-0654-z
Rengo JL, Savage PD, Shaw JC, et al. Ades PA. Directly measured physical function in cardiac rehabilitation. J Cardiopulm Rehabil Prev 2017;37:175-181. DOI: https://doi.org/10.1097/HCR.0000000000000231
Giallauria F, Vigorito C. Editorial to 'Comparison of phase 2 cardiac rehabilitation outcomes between patients after transcatheter versus surgical aortic valve replacement'. Eur J Prev Cardiol 2018;25:1575-6. DOI: https://doi.org/10.1177/2047487318798900
Ashikaga K, Saji M, Takanashi S, et al. Physical performance as a predictor of midterm outcome after mitral valve surgery. Heart Vessels 2019;34:1665-73. DOI: https://doi.org/10.1007/s00380-019-01397-y
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