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Review Article   

Panminerva Medica 2022 Mar 22

DOI: 10.23736/S0031-0808.22.04444-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Predictors of survival in patients undergoing cardiac rehabilitation after transcatheter aortic valve replacement (TAVR): a multicenter retrospective study

Franco TARRO GENTA 1 , Claudio MARCASSA 2, Monica CERESA 3, Simonetta SCALVINI 4, Laura A. DALLA VECCHIA 5, Maurizio BUSSOTTI 5, Gian L. IANNUZZI 6, Simona SARZI BRAGA 7, Caterina RIZZO 8, Roberto F. PEDRETTI 9, Andrea GIORDANO 10, Maria T. LA ROVERE 11

1 Division of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri Spa SB, Turin, Italy; 2 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Veruno, Novara, Italy; 3 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Pavia, Italy; 4 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Lumezzane, Brescia, Italy; 5 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Milan, Italy; 6 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Telese Terme, Benevento, Italy; 7 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Tradate, Varese, Italy; 8 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Bari, Italy; 9 Cardiology Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; 10 Service of Bioengineering, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Veruno, Novara, Italy; 11 Division of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri Spa SB, Montescano, Pavia, Italy


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AIMS: To evaluate cardiac rehabilitation (CR)-derived predictors of outcome in patients discharged from rehabilitation after transcatheter aortic valve replacement (TAVR).
METHODS: We retrospectively analyzed data from 232 TAVR patients (aged 82±6 years, 55% females) discharged following an average 3-week residential CR program in the period January 2009 to December 2017. Comorbidities (cumulative illness rated state-comorbidity index, CIRSCI), echocardiography on admission, disability (Barthel Index, BI) and functional capacity (6-min walk distance, 6MWD) at discharge, and maximal training session intensity expressed in METs/min were collected. The end-point was all-cause mortality.
RESULTS: 74 (32%) deaths occurred at 3-year follow-up. At discharge, non-survivors had a higher comorbidity rate (CIRS-CI 5.2±2.3 vs. 4.1±1.9, p=0.000), higher disability level (BI 80.4±24 vs. 88.8±17, p=0.000), and worse renal function (creatinine 1.6±0.9 vs. 1.2±0.4 mg/dl, p=0.000). They were also more often on diuretics (73% vs. 53.2%, p=0.003) and beta-blocker therapy (73% vs. 57.6%, p=0.042) and had a markedly reduced functional capacity (6MWD 221±100m vs. 265±105m, p=0.001). At multivariate Cox proportional hazards regression analysis, independent predictors of survival at follow-up were lower comorbidity rate, a better preserved renal function, lower use of diuretics, and a higher 6MWD at discharge (Harrell's C = 0.707).
CONCLUSIONS: Patients attending residential CR after TAVR are very old with significant comorbidity. The overall 3-year mortality rate after CR discharge is high. Our findings suggest the need for individually tailored follow-up care in patients discharged from CR after TAVR to address their residual exercise capacity, comorbidities, and renal function impairment.


KEY WORDS: TAVR; Cardiac rehabilitation; Aortic stenosis; Exercise capacity; Training; 6MWD

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