Ribeiro Gustavo S, Melo Rosangela D, Deresz Luís F, Dal Lago Pedro, Pontes Mauro Rn, Karsten Marlus
1 Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
2 Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Brazil.
Eur J Prev Cardiol. 2017 May;24(7):688-697. doi: 10.1177/2047487316686442. Epub 2017 Jan 10.
Background Aortic stenosis is a valvular heart disease characterised by fixed obstruction of the left ventricular outflow. It can be managed by surgical aortic valve replacement (sAVR) or transcatheter aortic valve implantation (TAVI). This review aimed to describe the evidence supporting a cardiac rehabilitation programme on functional capacity and quality of life in aortic stenosis patients after sAVR or TAVI. Methods The search was conducted on multiple databases from January to March 2016. All studies were eligible that evaluated the effects of a post-interventional cardiac rehabilitation programme in aortic stenosis patients. The methodological quality was assessed using the PEDro scale. Meta-analysis was performed separately by procedure and between procedures. The walked distance during the six-minute walk test (6MWD) and Barthel index were evaluated. The analysis was conducted in Review Manager. Results Five studies were included (292 TAVI and 570 sAVR patients). The meta-analysis showed that a cardiac rehabilitation programme was associated with a significant improvement in 6MWD (0.69 (0.47, 0.91); P < 0.001) and Barthel index (0.80 (0.29, 1.30); P = 0.002) after TAVI and 6MWD (0.79 (0.43, 1.15); P < 0.001) and Barthel index (0.93 (0.67, 1.18); P < 0.001) after sAVR. In addition, the meta-analysis showed that the cardiac rehabilitation programme promoted a similar gain in 6MWD (4.28% (-12.73, 21.29); P = 0.62) and Barthel index (-1.52 points (-4.81, 1.76); P = 0.36) after sAVR or TAVI. Conclusions The cardiac rehabilitation programme improved the functional capacity and quality of life in aortic stenosis patients. Patients who underwent TAVI benefitted with a cardiac rehabilitation programme similar to sAVR patients.
主动脉瓣狭窄是一种以左心室流出道固定梗阻为特征的心脏瓣膜疾病。可通过外科主动脉瓣置换术（sAVR）或经导管主动脉瓣植入术（TAVI）进行治疗。本综述旨在描述支持心脏康复计划对接受sAVR或TAVI治疗后的主动脉瓣狭窄患者的功能能力和生活质量影响的证据。
于2016年1月至3月在多个数据库进行检索。所有评估介入后心脏康复计划对主动脉瓣狭窄患者影响的研究均符合纳入标准。采用PEDro量表评估方法学质量。按手术方式分别及在不同手术方式之间进行荟萃分析。评估六分钟步行试验（6MWD）中的步行距离和巴氏指数。分析在Review Manager中进行。
纳入5项研究（292例TAVI患者和570例sAVR患者）。荟萃分析表明，心脏康复计划与TAVI术后6MWD显著改善相关（0.69（0.47，0.91）；P<0.001）以及巴氏指数改善相关（0.80（0.29，1.30）；P = 0.002），与sAVR术后6MWD改善相关（0.79（0.43，1.15）；P<0.001）以及巴氏指数改善相关（0.93（0.67，1.18）；P<0.001）。此外，荟萃分析表明，心脏康复计划在sAVR或TAVI术后促进6MWD获得相似的增加幅度（4.28%（-12.73，21.29）；P = 0.62）以及巴氏指数增加幅度相似（-1.52分（-4.81，1.76）；P = 0.36）。
心脏康复计划改善了主动脉瓣狭窄患者的功能能力和生活质量。接受TAVI治疗的患者从心脏康复计划中获益程度与接受sAVR治疗的患者相似。
