Changes in functional capacity with early inpatient cardiac rehabilitation following surgical or transcatheter aortic valve replacement for aortic stenosis

Abstract Background Severe aortic stenosis (AS) is associated with profound functional impairment. While valve replacement with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) is associated with improvements in symptoms and mortality, many patients experience persistent functional limitations that could benefit from early inpatient exercise-based cardiac rehabilitation (EBCR). Purpose To determine changes in functional capacity following early inpatient EBCR following SAVR or TAVI for severe AS, and to determine if this differs by surgical approach (SAVR vs TAVR). Methods Patients referred for early inpatient EBCR following SAVR or TAVI between December 2022 and June 2024 who completed six-minute walk test assessments at admission and discharge from EBCR were included in this retrospective single-center study. Functional capacity was assessed from the distance covered during a six-minute walk test (6MWD) completed in accordance with guidelines from the American Thoracic Society. Patients were sub-grouped into TAVI (n=33) and SAVR approaches including mini-thoracotomy (n=22), hemi-sternotomy (n=67) and sternotomy (n=24). Results for 6MWD were compared in relation to normative age-, sex- and body mass index predicted 6MWD values for patients undergoing EBCR from our center, as well as published predictive 6MWD values for community-dwelling healthy older adults. Results Overall, 146 patients were included in the current analysis. Compared to the SAVR groups, patients who had undergone TAVI were older and had a higher proportion of females (Table 1). At admission, and regardless of the surgical approach, all patient groups had 6MWD values that were well below healthy reference values (Figure 1). TAVI patients had lower 6MWD than all three SAVR groups (P=0.035), although, this was largely explained by their older age, as the deficit in 6MWD relative to age-matched healthy referent values was similar to SAVR-sternotomy and SAVR-hemi-sternotomy (but not SAVR mini-thoracotomy) groups. All groups showed substantial improvements in 6MWD following inpatient EBCR (Table 1 and Figure 1), although TAVI patients showed significantly less (P=0.006) improvement (84m [45-124m]) than SAVR-mini-thoracotomy (128, [95-151m]), SAVR-hemi-sternotomy (147m [98-196m]) and SAVR-sternotomy patients (159m [100-223m]), such that their median post-EBCR 6MWD values remained 123-138m below the median value for the SAVR groups (P<0.001), and failed to reach age-predicted healthy referent values. Conclusion Early inpatient EBCR results in significant improvements in functional capacity for patients who have undergone TAVI or SAVR for severe AS. However, TAVI patients experience lesser improvements and persistent functional limitations at discharge compared to SAVR patients, that suggests a longer period of EBCR may be required for this vulnerable patient population.Regression of age vs 6MWD Baseline characteristics

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