Russo Nicola, Compostella Leonida, Tarantini Giuseppe, Setzu Tiziana, Napodano Massimo, Bottio Tomaso, D'Onofrio Augusto, Isabella Gianbattista, Gerosa Gino, Iliceto Sabino, Bellotto Fabio
Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.
Eur J Prev Cardiol. 2014 Nov;21(11):1341-8. doi: 10.1177/2047487313494029. Epub 2013 Jun 11.
Transcatheter aortic valve implantation plays a leading role in the management of aortic stenosis in patients with comorbidities but no data are available about cardiac rehabilitation in these subjects. This study aimed to compare safety and efficacy of an early, exercise-based, cardiac rehabilitation programme in octogenarians after a traditional surgical aortic valve replacement versus transcatheter aortic valve implantation.
Seventy-eight consecutive transcatheter aortic valve implantation patients were studied in order to evaluate the effect of an exercise-based cardiac rehabilitation programme in comparison to 80 of a similar age having surgical aortic valve replacement. Functional capacity was assessed by a 6 min walking test on admission and at the end of the programme. When possible, a cardiopulmonary exercise test was also performed before discharge.
The two groups were similar in terms of gender and length of stay in cardiac rehabilitation; as expected, the transcatheter aortic valve implantation group had more comorbidities but no major complications occurred in either group during rehabilitation. All patients enhanced autonomy and mobility and were able to walk at least with the assistance of a stick. In those patients who were able to perform the 6 min walking test, the distance walked at discharge did not significantly differ between the groups (272.7 ± 108 vs. 294.2 ± 101 m, p = 0.42), neither did the exercise capacity assessed by cardiopulmonary exercise test (peak-VO2 12.5 ± 3.6 vs. 13.9 ± 2.7 ml/kg/min, p = 0.16).
Cardiac rehabilitation is feasible, safe and effective in octogenarian patients after transcatheter aortic valve implantation as well as after traditional surgery. An early cardiac rehabilitation programme enhances independence, mobility and functional capacity and should be highly encouraged.
经导管主动脉瓣植入术在合并症患者的主动脉瓣狭窄治疗中起主导作用，但尚无关于这些患者心脏康复的数据。本研究旨在比较传统外科主动脉瓣置换术与经导管主动脉瓣植入术后老年患者早期基于运动的心脏康复计划的安全性和有效性。
连续研究78例经导管主动脉瓣植入术患者，以评估基于运动的心脏康复计划的效果，并与80例年龄相仿的接受外科主动脉瓣置换术的患者进行比较。入院时和康复计划结束时通过6分钟步行试验评估功能能力。尽可能在出院前进行心肺运动试验。
两组在性别和心脏康复住院时间方面相似；正如预期的那样，经导管主动脉瓣植入术组合并症更多，但康复期间两组均未发生重大并发症。所有患者的自主性和活动能力均有所提高，至少能够在拐杖辅助下行走。在能够进行6分钟步行试验的患者中，出院时行走的距离在两组之间无显著差异（272.7±108米对294.2±101米，p = 0.42），通过心肺运动试验评估的运动能力也无显著差异（峰值摄氧量12.5±3.6对13.9±2.7毫升/千克/分钟，p = 0.16）。
心脏康复在经导管主动脉瓣植入术后以及传统手术后的老年患者中是可行、安全且有效的。早期心脏康复计划可提高独立性、活动能力和功能能力，应大力提倡。
