Changes in Exercise Capacity Following TAVR

Study Questions:

Does exercise capacity improve after transcatheter aortic valve replacement (TAVR)?

Methods:

Patients who were undergoing TAVR were included in the present study. Mean age was 79.9 years and 44% were male. Mean Society of Thoracic Surgeons (STS) score was 6.7% ± 4.2%. Exercise capacity was assessed at baseline and 6 months post-TAVR with 6-minute walk testing (6MWT). Clinical outcomes included all-cause death, cardiovascular death, rehospitalization for cardiovascular reasons, and a combined cardiovascular endpoint of cardiovascular death or re-hospitalization for cardiovascular reasons.

Results:

A total of 305 patients were included in this study. The mean overall distances walked pre- and 6 months post-TAVR were 204 ± 119 and 263 ± 116 m, respectively (change in 6MWT = 60 ± 106 m), with 219 (72%) patients demonstrating an increase in their walking distance. Older age, female sex, and chronic obstructive pulmonary disease were associated with reduced improvement in exercise capacity. Bleeding (periprocedural or life-threatening) and new-onset anemia at 6 months post-TAVR were also associated with lack of improvement. Failure to improve the 6MWT distance by at least 20% was independently associated with all-cause death (p = 0.002), cardiovascular death, or re-hospitalization for cardiovascular causes (p = 0.001). Patients who were slow walkers and who were able to improve the 6MWT distance presented with significantly better outcomes than non-improvers (p = 0.01 for all-cause death; p = 0.001 for cardiovascular endpoint).

Conclusions:

The authors concluded that the lack of functional improvement post-TAVR was predicted by a mix of baseline and periprocedural factors translating into poorer clinical outcomes. These results suggest that systematically implementing exercise capacity assessment pre- and post-TAVR may help to improve patient risk-stratification.

Perspective:

These data suggest that functional testing can give providers and patients added information on risk for worse outcomes, and may be used to improve shared decision making.

Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease, Exercise

Keywords: Anemia, Cardiac Surgical Procedures, Geriatrics, Heart Function Tests, Heart Valve Diseases, Hemorrhage, Outcome Assessment (Health Care), Primary Prevention, Pulmonary Disease, Chronic Obstructive, Transcatheter Aortic Valve Replacement, Walking


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