CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE

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1 ESC Congress Aug - 31 Aug 2011, Paris - France CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE N.Russo, L.Compostella, T.Setzu, M.Napodano, L.Testolin, G.Isabella, G.Gerosa, S.Iliceto, F.Bellotto Preventive Cardiology and Rehabilitation, Istituto Codivilla Putti di Cortina d Ampezzo Dpt of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School Conflicts of interest, sources of support and funding disclosure: none

2 Aortic Stenosis Ross J, Braunwald E. Circulation 1968;38:61-67 and Ross J Jr. JACC 2008;51:

3 Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement Varadarajan P et al. Euro J Cardiothorac Surg 2006; 30:

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5 Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery Leon MB, Smith CR, et al. NEJM 2010; 363:

6 Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients Smith CR, Leon MB, et al. NEJM 2011; 364:

7 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Cardiac Rehabilitation (CR) is a well-established treatment in patients who underwent cardiac surgery. Beneficial effects on exercise capacity, quality of life and reduction of recurrent events and hospitalization are reported in various studies using different programs. After Transcatheter Aortic Valve Implantation (TAVI), older patients with more compromised conditions are natural candidates for referral to in-hopital CR programs No data are available, until now, about the safety, efficacy and duration of cardiac rehabilitation in these subjects.

8 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE A prospective single centre study (July 2008-April 2011) to evaluate safety and efficacy of early cardiac rehabilitation in elderly patients (>75 y) who underwent TAVI CoreValve=15 Edwards AP=11 45 TAVI 48 savr (as control) Mean age: 82.1 ± 3.6 Edwards TF=19 TAVI=TRANSCATHETER AORTIC VALVE IMPLANTATION savr = SURGICAL AORTIC VALVE REPLACEMENT AP= transapical approach TF=transfemoral approach

9 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Clinical features (1) TAVI savr ALL p n=45 n=48 n=93 Age (y) 83.3± ± ± Age [min-max] [77-89] [76-88] [76-89] Male (%) Time impl-rehab (days) 13.3± ± ± Stay in CR (days) 16.6± ± ± Drop out (n/tot) (%) 1/45 (2.2%) 1/48 (2.0%) 2/90 (2.2%) 0.89 Causes Arrhythmias Acute Abdomen

10 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Clinical features (2) TAVI (n=45) savr (n=48) ALL (n=93) p Hypertension (%) Diabetes (%) Pre-diabetes (%) Met Synd (%) Coronary art dis (%) Prev MI (%) Prev PCI (%) <0.01 Prev CABG (%) Vascular disease (%) Pulmonary disease (%) Renal Failure (%) Cancer (%)

11 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Clinical features (3) TAVI (n=45) savr (n=48) ALL (n=93) p New Pace Maker (%) Atrial fibrillation (%) LBBB (%) <0.01 BMI (kg/m 2 ) 24.7± ± ± Hb value at entry (g/dl) 10.3± ± ± LVEF (%) 56.3± ± ± NYHA 2.93± ± ±

12 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Exercise based Cardiac Rehabilitation 3 sets of exercises, 6 days a week each session supervised by a physician and a physiotherapist

13 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Barthel Index TAVI savr ALL p At entry B.I. 80.9± ± ± At discharge B.I. 90.3± ± ± Δ B.I. 9.3± ± ± At the end of the CR period, all patients enhanced independence and mobility and were able to walk al least with the assistance of a stick

14 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE 6MWT 289 ± 99 savr (n = 42) 266 ± ± 97 TAVI (n = 31) 238 ± 95 mean Δ6MWT: + 66±54 P<0.01

15 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE CPET peak VO 2 (ml/kg/min) p=0.13 savr (n = 31) TAVI (n = 17)

16 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Functional status TAVI savr ALL p 6MWT (n/tot) (%) 31/45 (69%) 42/48 (88%) 73/93 (78%) At entry (mt) 237.8± ± ± Pre-discharge (mt) 266.6± ± ± Δ6MWT (mt) 58.0± ± ± CPET (n/tot) (%) 17/45 (38%) 31/48 (65%) 48/93 (52%) Peak VO2 (ml/kg/min) 12.2± ± ±

17 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Conclusions In elderly patients after TAVI, intensive, exercised based CR is feasible, safe and effective as after traditional cardiac surgery In our experience, the length of the hospital stay was relatively brief, despite the older age and the number of comorbidities of the patients enrolled Intensive CR should be encouraged in TAVI patients in order to optimize functional recovery and reduce the length of stay in acute care divisions

18 CARDIAC REHABILITATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE CENTRE EXPERIENCE Limitations This is an observational clinical study and not a randomized trial These preliminary data need to be extended

19 Grazie dell attenzione.. Thank You