Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation

BACKGROUND: Transcatheter aortic-valve implantation (TAVI) is an established alternative therapy in patients with severe aortic stenosis and a high surgical risk. Despite a rapid growth in its use, very few data exist about the efficacy of cardiac rehabilitation (CR) in these patients. We assessed the hypothesis that patients after TAVI benefit from CR, compared to patients after surgical aortic-valve replacement (sAVR).

METHODS: From September 2009 to August 2011, 442 consecutive patients after TAVI (n = 76) or sAVR (n = 366) were referred to a 3-week CR. Data regarding patient characteristics as well as changes of functional (6-min walk test. 6-MWT), bicycle exercise test), and emotional status (Hospital Anxiety and Depression Scale) were retrospectively evaluated and compared between groups after propensity score adjustment.

RESULTS: Patients after TAVI were significantly older (p < 0.001), more female (p < 0.001), and had more often coronary artery disease (p = 0.027), renal failure (p = 0.012) and a pacemaker (p = 0.032). During CR, distance in 6-MWT (both groups p ≤ 0.001) and exercise capacity (sAVR p ≤ 0.001, TAVI p ≤ 0.05) significantly increased in both groups. Only patients after sAVR demonstrated a significant reduction in anxiety and depression (p ≤ 0.001). After propensity scores adjustment, changes were not significantly different between sAVR and TAVI, with the exception of 6-MWT (p = 0.004).

CONCLUSIONS: Patients after TAVI benefit from cardiac rehabilitation despite their older age and comorbidities. CR is a helpful tool to maintain independency for daily life activities and participation in socio-cultural life.