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

Abstract

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). 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. 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). 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.