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

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