Sage Journals: Discover world-class research

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.

Keywords

Aortic valve stenosis transcatheter aortic valve implantation surgical aortic valve replacement exercise cardiac rehabilitation

Get full access to this article

View all access options for this article.

References

Ozkan

Kapadia

Tuzcu

. Assessment of left ventricular function in aortic stenosis. Nat Rev Cardiol 2011; 8: 494–501.

Vahanian

Alfieri

Andreotti

. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451–2496.

Grimard

Safford

Burns

. Aortic stenosis: diagnosis and treatment. Am Fam Physician 2016; 93: 371–378.

Pereira

Silva

Caeiro

. What has changed in surgical treatment of severe aortic stenosis with the advent of percutaneous intervention? Rev Port Cardiol 2013; 32: 749–756.

Carabello

Paulus

. Aortic stenosis. Lancet 2009; 373: 956–966.

Leon

Smith

Mack

. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–1607.

Green

Cohen

Généreux

. Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER trial). Am J Cardiol 2013; 112: 700–706.

Reynolds

Magnuson

Wang

. Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation 2012; 125: 1102–1109.

Singh

Stewart

White

. Importance of frailty in patients with cardiovascular disease. Eur Heart J 2014; 35: 1726–1731.

10.

Fauchere

Weber

Maier

. Rehabilitation after TAVI compared to surgical aortic valve replacement. Int J Cardiol 2014; 173: 564–566.

11.

Russo

Compostella

Tarantini

. Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly. Eur J Prev Cardiol 2014; 21: 1341–1348.

12.

Voller

Salzwedel

Nitardy

. Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation. Eur J Prev Cardiol 2015; 22: 568–574.

13.

Tarro-Genta

Eleuteri

Bertolin

. Is cardiac rehabilitation safe and useful in octogenarians after transcatheter aortic valve implantation compared to surgical aortic valve replacement for aortic stenosis? Eur Heart J 2015; 36(Suppl): 515–515.

14.

Zanettini

Gatto

Mori

. Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation. J Geriatr Cardiol 2014; 11: 279–285.

15.

Moher

Hopewell

Schulz

. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 2012; 10: 28–55.

16.

Landis

Koch

. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

17.

Foley

Bhogal

Teasell

. Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Phys Ther 2006; 86: 817–824.

18.

Faraone

. Interpreting estimates of treatment effects: implications for managed care. Pharm Therapeut 2008; 33: 700–711.

19.

Gremeaux

Troisgros

Benaim

. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil 2011; 92: 611–619.

20.

United Nations. World Population Ageing 2015 [Internet]. New York, USA: Department of Economic and Social Affairs, Population Division; 2015. Report No.: ST/ESA/SER.A/390. www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf (accessed 20 September 2016).

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.21 MB

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