Short-term clinical outcomes after transcatheter aortic valve replacement (TAVR) were found to improve with intensified physiotherapy, according to a study published in the Journal of Interventional Cardiology.

In this prospective, single center, randomized trial (Use of Pre- and Intensified Postprocedural Physiotherapy in Patients with Symptomatic Aortic stenosis undergoing TAV Implantation Trial (4P-TAVR study), 108 patients (mean age, 82.0±5.5 years; 50.9% women) undergoing TAVR were recruited between 2012 and 2017 from the Heart Center Bonn in Germany. Patients were randomly assigned at a 1:1 ratio to receive 2-weeks of daily ambulatory physiotherapy exercises (4 inspiratory muscle training sessions lasting 5 minutes, and 30 minutes of walking) prior to and following TAVR, as well as 2 sessions of daily physiotherapy until discharge for 30 minutes (n=58), or the control condition (a single 30-minute daily physiotherapy session after TAVR; n=50). The study’s endpoints included pulmonary complications, rehospitalizations, and mortality up to 90 days after intervention.

In this cohort, mean left ventricular ejection fraction was 54.0%±12.9%, and 93% of patients had a New York Heart Association class >2.


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Mean scores for motivation and endurance among patients in the intervention group were 2.5±0.9 and 2.6±1.2, respectively, on a 4-point scale. No adverse effects were reported by patients over of period of 30.2±19.9 days.

Patients receiving the intervention vs control condition tended to have a greater daily step count (1024±1301 vs 515±910, respectively; P =.079) and greater energy turnover (7628.2±2281.5 kilojoules vs 5062.8±4264.2 kilojoules, respectively; P =.001) before TAVR.

Patients receiving intensified physiotherapy vs the control condition had shorter hospital stays (10.1±4.7 days vs 13.5±6.1 days, respectively; P =.023) and lower rates of pneumonia after TAVR (5.1% vs 20.0%, respectively; P =.016) and of postoperative pulmonary complications (6.9% vs 20.0%, respectively; P =.028). Other primary outcomes, including 90-day rehospitalizations, cardiovascular complications, and mortality were comparable between the 2 groups (P >.20 for all).

Length of treatment in the intensive care unit (ICU; odds ratio [OR], 1.58; 95% CI, 1.15-2.17; P =.005) and maximal inspiratory pressure (OR, 0.95; 95% CI, 0.92-0.99; P =.03) were found to represent independent predictors of the composite of 90-day mortality and rehospitalization. In addition, length of stay in the ICU was the only potential confounder examined found to independently predict the occurrence of pneumonia (OR, 1.38; 95% CI, 1.04-1.8; P =.025).

This study was limited by the small sample size, as the investigators failed to reach their goal of recruiting 220 patients due to the time constrains of requiring a 2-week lead-in period before surgery.

“Intensified peri-interventional physiotherapy was shown to be safe and could have positive effects on clinical outcome up to 90 days after TAVR,” concluded the study authors.

Reference

Weber M, Klein U, Weigert A, et al. Use of Pre- and Intensified Postprocedural Physiotherapy in Patients with Symptomatic Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement Study (the 4P-TAVR Study). J Interv Cardiol. 2021;2021:8894223. doi:10.1155/2021/8894223