Exercise and Diet Supplements for Older Patients Undergoing TAVI: the IRON-TAVI Trial (IRON-TAVI)

he IRON-TAVI trial is a prospective, randomized, multicenter study evaluating whether a multidomain rehabilitation program can improve outcomes in older patients undergoing transcatheter aortic valve implantation for severe symptomatic aortic stenosis.

The study will enroll approximately 450 patients aged 75 years or older who have reduced physical performance and/or impaired nutritional status. Participants will be randomly assigned in a one-to-one ratio to either standard care or a multidomain intervention in addition to standard care.

The multidomain intervention includes a personalized exercise program, combining supervised sessions before and after transcatheter aortic valve implantation with home-based exercises, together with individualized nutritional counseling and oral supplementation containing protein and iron. The intervention starts before the valve procedure and continues during the first three months after the procedure.

The study will assess whether this strategy improves clinical outcomes, physical performance, nutritional status, and quality of life compared with standard care alone. The main outcome will be the occurrence within one year of death from any cause, stroke, or hospital readmission for cardiovascular causes.

Study Overview

• Status: Recruiting
• Conditions: Aortic Stenosis; Aortic Stenosis Symptomatic; Aortic Stenosis Disease
• Intervention / Treatment: Behavioral: Personalized Multidomain Exercise Program; Dietary supplement: Oral Protein and Iron Nutritional Supplementation; Other: Usual Care

Detailed Description

Severe symptomatic aortic stenosis mainly affects older adults and is frequently associated with reduced physical performance, frailty, sarcopenia, and impaired nutritional status. Although transcatheter aortic valve implantation effectively treats the valvular obstruction, a substantial proportion of older patients experience incomplete functional recovery, persistent disability, reduced quality of life, or hospital readmission after an otherwise successful procedure.

Reduced physical performance and impaired nutritional status are clinically relevant because they are common, strongly associated with adverse outcomes, and potentially modifiable. The IRON-TAVI trial has therefore been designed to test whether a structured multidomain intervention targeting these two domains can improve outcomes in older patients undergoing transcatheter aortic valve implantation.

The study is a prospective, randomized, multicenter, open-label superiority trial with blinded adjudication of clinical events. Approximately 450 patients aged 75 years or older with severe symptomatic aortic stenosis and a Heart Team indication to transcatheter aortic valve implantation will be enrolled. Eligible patients must also have reduced physical performance, defined by a Short Physical Performance Battery score below 10, and/or impaired nutritional status, defined by a Mini Nutritional Assessment Short Form score below 12.

After confirmation of eligibility and written informed consent, participants will be randomly assigned in a one-to-one ratio to either standard care or the multidomain intervention in addition to standard care. Randomization will be centralized and stratified by participating center, sex, baseline physical performance, and baseline nutritional status.

Patients assigned to the multidomain intervention will receive a personalized exercise and nutritional program beginning before transcatheter aortic valve implantation and continuing for three months after the procedure. The exercise component includes five supervised sessions, two before and three after the valve procedure, together with an individualized home-based exercise program. Exercise activities include walking, mobility exercises, sit-to-stand exercises, balance training, and progressive functional strengthening. Exercise intensity and progression are adapted to the patient's clinical condition, symptoms, physical performance, and tolerance.

The nutritional component includes individualized dietary counseling and daily oral supplementation containing protein and iron. The intervention is intended to support adequate nutritional intake, preserve or improve muscle function, and promote functional recovery before and after transcatheter aortic valve implantation. Adherence, tolerance, and safety of both the exercise and nutritional components will be monitored throughout the intervention period.

Patients assigned to the control group will receive standard care according to current clinical practice, including transcatheter aortic valve implantation, medical therapy, routine advice on physical activity and diet, and standard follow-up. No structured study-driven exercise or nutritional supplementation program will be provided in the control group.

All participants will be followed for 12 months after randomization. Clinical outcomes will be adjudicated by an independent committee blinded to treatment allocation. The primary clinical outcome is the one-year occurrence of death from any cause, stroke, or hospital readmission for cardiovascular causes. Secondary assessments include mortality, cardiovascular events, hospital readmission, physical performance, nutritional status, sarcopenia-related measures, and health-related quality of life.

• Study Type: Interventional
• Enrollment (Estimated): 450
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Veronica Lodolini; Phone Number: +39 0532236450; Email: ldlvnc@unife.it

Study Locations

• Italy
  • FE
    • Ferrara, FE, Italy
      • Recruiting
      • Azienda Ospedaliero Universitaria di Ferrara
      • Contact: Elisabetta Tonet; Phone Number: +39 0532237227; Email: tonet.elisabetta@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age ≥75 years
• Symptomatic aortic stenosis
• Indication to transcatheter aortic valve implantation (TAVI) confirmed by the Heart Team
• Reduced physical performance defined as Short Physical Performance Battery (SPPB) score <10 and/or poor nutritional status defined as Mini Nutritional Assessment Short Form (MNA-SF) score <12
• Written informed consent

Exclusion Criteria:

• Non-cardiovascular co-morbidity reducing life expectancy to <1 year
• Any factor precluding 1-year follow-up
• Extra-cardiovascular condition precluding participation in the exercise training sessions
• Refusal or inability to provide written informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Multidomain intervention; Participants will receive standard care plus a personalized multidomain program including supervised exercise sessions before and after transcatheter aortic valve implantation, a structured home-based exercise program, individualized nutritional counseling, and daily oral protein and iron supplementation. The intervention starts before the procedure and continues for three months after transcatheter aortic valve implantation.	Behavioral: Personalized Multidomain Exercise Program; Participants assigned to the multidomain intervention will receive a personalized exercise training program beginning before transcatheter aortic valve implantation and continuing for three months after the procedure. The program includes five supervised exercise sessions, two before and three after the procedure, together with a structured home-based exercise program. Exercise includes walking, mobility exercises, sit-to-stand exercises, balance training, and progressive functional strengthening. Exercise intensity and progression will be individualized according to symptoms, physical performance, clinical condition, and exercise tolerance.; Dietary supplement: Oral Protein and Iron Nutritional Supplementation; Participants assigned to the multidomain intervention will receive individualized nutritional counseling and daily oral nutritional supplementation containing protein and iron. Supplementation will start after randomization, before transcatheter aortic valve implantation, and will continue for three months after the procedure. The nutritional intervention will be adapted according to baseline nutritional status, body weight, appetite, renal function, clinical condition, and tolerance. Adherence and tolerability will be monitored throughout the intervention period.
Other: Standard of care; Participants will receive standard care according to current clinical practice, including transcatheter aortic valve implantation, guideline-directed medical management, routine follow-up, and general advice regarding physical activity and a balanced diet. No structured study-driven exercise program or protocol-mandated nutritional supplementation will be provided.	Other: Usual Care; Participants assigned to the control group will receive standard care according to current clinical practice, including transcatheter aortic valve implantation, guideline-directed medical management, routine follow-up, and general advice regarding physical activity and a balanced diet. No structured study-driven exercise program or protocol-mandated nutritional supplementation will be provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First All-Cause Death, Stroke, or Hospital Readmission for Cardiovascular Causes	Composite clinical outcome defined as the time from randomization to the first occurrence of all-cause death, stroke, or hospital readmission for cardiovascular causes. Clinical events will be independently adjudicated by a blinded Clinical Event Committee according to Valve Academic Research Consortium-3 definitions whenever applicable.	From randomization through 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause death	Clinical outcome defined as the time from randomization to the first occurrence of all-cause death.	From randomization through 12 months
Cardiovascular death	Clinical outcome defined as the time from randomization to the first occurrence of cardiovascular death.	From randomization through 12 months
Stroke	Clinical outcome defined as the time from randomization to the first occurrence of stroke.	From randomization through 12 months
Myocardial infarction	Clinical outcome defined as the time from randomization to the first occurrence of myocardial infarction.	From randomization through 12 months
Hospital readmission for heart failure	Clinical outcome defined as the time from randomization to the first occurrence of hospital readmission for heart failure	From randomization through 12 months
Hospital readmission for cardiovascular cause	Clinical outcome defined as the time from randomization to the first occurrence of hospital readmission for cardiovascular cause	From randomization through 12 months
Hospital readmission for any cause	Clinical outcome defined as the time from randomization to the first occurrence of hospital readmission for any cause	From randomization through 12 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary safety endpoint	The primary safety endpoint is the cumulative occurrence of adverse events related to exercise training or dietary supplementation. These include, but are not limited to, angina resurgence, heart failure worsening, bleeding, falls or traumatism related to exercise training, and worsening renal function or other clinically relevant adverse effects related to dietary supplementation.	From randomization through 12 months

Collaborators and Investigators

• Sponsor: University Hospital of Ferrara
• Investigators: Principal Investigator: Elisabetta Tonet, MD, University Hospital of Ferrara; Study Chair: Gianluca CAMPO, MD, University Hospital of Ferrara

Study record dates

Study Major Dates

• Study Start (Actual): November 4, 2026
• Primary Completion (Estimated): November 30, 2029
• Study Completion (Estimated): November 30, 2031

Study Registration Dates

• First Submitted: October 19, 2026
• First Submitted That Met QC Criteria: October 19, 2026
• First Posted (Actual): October 26, 2026

Study Record Updates

• Last Update Posted (Actual): November 5, 2026
• Last Update Submitted That Met QC Criteria: November 4, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: prehabilitation; aortic stenosis; transcatheter aortic valve implantation; cardiac rehabilitation
• Additional Relevant MeSH Terms: Aortic Valve Disease; Cardiovascular Diseases; Heart Diseases; Heart Valve Diseases; Ventricular Outflow Obstruction; Aortic Valve Stenosis; Amino Acids, Peptides, and Proteins; Proteins
• Other Study ID Numbers: 341/2026/Sper/AOUFe; GR-2024-12377447 (Other Grant/Funding Number: Italian Health Minister - Ricerca Finalizzata 2024)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

IPD Plan Description

Individual participant data sharing is not currently planned. However, reasonable requests for access to de-identified study data may be considered after publication of the main study results. Any such request will be evaluated by the Steering Committee on a case-by-case basis, taking into account the scientific rationale, proposed analyses, data protection requirements, participant confidentiality, and applicable regulatory and institutional policies.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No