Patients with Aortic Stenosis can be treated with Transcatheter Aortic Valve Replacement (TAVI), a less invasive surgical procedure for Aortic Stenosis than traditional Aortic Valve replacement.
This procedure is often reserved for elderly, multi-morbid patients with high peri-operative mortality risk. This population represent a unique group, as they are usually extremely limited in their ability to perform physical activity prior to an intervention, may be limited by medications and are often severely deconditioned due to other co-morbidities.
Despite this, there is limited evidence of the effects of physical rehabilitation after TAVI. Through the Active Hospital pilot we aimed to assess the effects of exercise intervention on health-related quality of life and the physical functioning of patients receiving the TAVI procedure.
Aortic stenosis (AS) can impair outflow of blood from the heart and is usually a progressive condition which can lead to left ventricular hypertrophy and progressive heart failure. Symptomatic aortic stenosis with angina, syncope or heart failure is associated with an annual mortality rate of around 25%. Without improvement of the obstruction to the aortic outflow, this condition has a very poor prognosis (1). Despite this, up to two-thirds of patients with severe AS do not undergo Surgical Aortic Valve Replacement (SAVR) due to their co-morbidities (2).
Interventional techniques for valvular heart disease have been rapidly growing in recent years, spearheaded by Transcatheter Aortic Valve Implantation (TAVI), as this valve replacement procedure is less invasive than traditional Surgical Aortic Valve Replacement, making it an attractive treatment alternative for elderly, multi-morbid patients with high peri-operative mortality risk.
- Liu, Z. (2018). Transcatheter aortic valve implantation for aortic stenosis in high surgical risk patients: A systematic review and meta-analysis. PLoS ONE. doi:10.1371/journal.pone.0196877
- Rajeswaran, J., Brozzi, N., Mack, M., Miller, D. C., Tuzcu, E. M., Kapadia, S., e.a. (2014). Comprehensive Analysis of Mortality Among Patients Undergoing TAVR. Journal of the American College of Cardiology, 64(2), 158–168. doi:10.1016/j.jacc.2013.08.1666
Patients with symptomatic AS represent a unique group, as they are usually extremely limited in their ability to perform physical activity (PA) prior to an intervention. They are further limited by use of rhythm and/or rate control medications, which makes engaging in physical activity very difficult.
After the TAVI procedure, the greatest barrier to performing exercise is removed, however patients are often left severely deconditioned and often with significant limitation due to other co-morbidities.
Exercise has been shown to improve outcomes in elderly patients with a variety of cardiac disorders, but there is scarce currently available prospective data from randomised trials on exercise after TAVI.
Cardiac rehabilitation has been predominately directed towards patients with ischaemic heart disease. Chronic physical activity limitation in patients with symptomatic AS results in poor engagement in organised cardiac rehabilitation, post intervention. In Denmark, despite high availability of cardiac rehabilitation services, only half the number of patients take up the opportunity for post-intervention rehabilitation (1).
- Hansen, T. B., Berg, S. K., Sibilitz, K. L., Søgaard, R., Thygesen, L. C., Yazbeck, A.-M., & Zwisler, A. D. (2014). Availability of, referral to and participation in exercise-based cardiac rehabilitation after heart valve surgery: Results from the national CopenHeart survey. European Journal of Preventive Cardiology, 22(6), 710–718. doi:10.1177/2047487314536364