Beyond TAVI: Cardiac Rehabilitation as a Determinant of Clinical Outcomes

Aortic stenosis is an increasingly prevalent condition associated with population aging, with a prevalence of approximately 3.4% in individuals over 75 years of age and a projected threefold increase by 2060. TAVI has been shown to improve survival and symptoms, expanding from inoperable or high-risk patients to lower-risk populations. However, these patients remain predominantly elderly, frail, and burdened with multiple comorbidities, leading to functional limitations, impaired quality of life, and challenges in postprocedural recovery. 

In this context, cardiac rehabilitation (CR) emerges as a central component of secondary prevention, with a proven impact on mortality, morbidity, rehospitalizations, and functional capacity.

From a pathophysiological perspective, TAVI corrects valvular obstruction and improves hemodynamics, but peripheral, muscular, and functional alterations persist in these patients. CR targets these mechanisms through regular aerobic exercise, improving endothelial function, ventilatory capacity, and muscle metabolism, with increases in peak VO₂ and overall functional capacity.

In terms of clinical outcomes, participation in CR programs is associated with a 61% relative reduction in one-year mortality, a 4.2% absolute reduction, and a 34% decrease in the risk of rehospitalization. Additionally, it improves quality of life, exercise capacity, and overall functional status. However, real-world adherence remains low: only 39.8% of patients in the United States and 12.4% in China access CR programs, highlighting a significant gap between recommendations and clinical practice.

Read also: Comparative outcomes between transaxillary approach and thoracotomy-based approaches in TAVI with alternative access.

Post-TAVI CR should be a multimodal intervention integrating four key pillars: exercise, nutritional support, psychological support, and risk factor control. Exercise is the most extensively studied component, with programs combining moderate aerobic training, strength, and balance exercises, performed in 30–45-minute sessions, 2–5 times per week over 8–12 weeks. These programs typically include an initial supervised phase (first 6–8 weeks), followed by home-based training, with early initiation after the procedure and gradual progression according to tolerance and degree of frailty, achieving significant improvements in functional capacity. 

Regarding nutrition, malnutrition is highly prevalent (up to 60% depending on the index used) and is associated with worse prognosis; for example, in one study, malnourished patients had a one-year mortality of 28% compared with 10% in those with adequate nutritional status, reflecting its strong prognostic impact. Psychologically, the prevalence of anxiety and depression reaches 25–30%, also correlating with poorer clinical outcomes. Finally, risk factor control (smoking, hypertension, dyslipidemia, diabetes) is essential not only for preventing cardiovascular events but also for ensuring prosthesis durability.

A central aspect is frailty, present in 26–68% of patients, which directly impacts mortality and disability. CR should be individualized according to the degree of frailty, starting with low intensity and slow progression in more severe cases. Additionally, post-TAVI complications (AV block, need for pacemaker, vascular complications, stroke, renal failure) require dynamic adaptation of the rehabilitation program.

Read also: Calcified Nodules and Their Treatment with Rotational Atherectomy.

The article also highlights the growing role of digital rehabilitation, using remote devices and mobile applications that enable monitoring and training at a distance. These strategies have demonstrated outcomes comparable to traditional rehabilitation and, in some studies, lower rehospitalization rates, suggesting they may improve adherence and access to treatment.

Cardiac Rehabilitation After TAVI: Impact on Mortality, Rehospitalizations, and Quality of Life

Cardiac rehabilitation after TAVI is a safe, effective, and underutilized intervention that improves functional capacity, quality of life, and reduces clinical events. Its implementation should be systematic and early, with a personalized and multimodal approach that addresses frailty, nutrition, psychological status, and comorbidities. The future points toward more accessible, digitalized, and multidisciplinary programs, with a need for high-quality evidence to standardize protocols.

Original Title: Cardiac rehabilitation for TAVR patients: mechanisms, current status, and future directions.

Reference: Huan Duan, Chuan Zhang, Qi Zhang, Duan Chen, Ling Xue. Frontiers in Cardiovascular Medicine, volumen 12, artículo 1701764, 2025. DOI: 10.3389/fcvm.2025.1701764.