Exercise-based cardiac rehabilitation for patients following open surgical aortic valve replacement and transcatheter aortic valve implant: a systematic review and meta-analysis

Lizette Anayo, Paula Rogers, Linda Long, Miles Dalby, Rod Taylor, Lizette Anayo, Paula Rogers, Linda Long, Miles Dalby, Rod Taylor

Abstract

Objectives: Exercise-based cardiac rehabilitation (CR) may be beneficial to patients following transcatheter aortic valve implantation (TAVI) and open surgical aortic valve replacement (SAVR). We aimed to undertake a systematic review and meta-analysis to evaluate the efficacy, safety and costs of exercise-based CR post-TAVI and post-SAVR.

Methods: We searched numerous databases, including Embase, CENTRAL and MEDLINE, up to October 2017. We included randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCTs) of exercise-based CR compared with no exercise control in TAVI or SAVR patients ≥18 years. Data extraction and risk of bias assessments were performed independently by two reviewers. Narrative synthesis and meta-analysis (where appropriate) were carried out for all relevant outcomes, and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis was also performed.

Results: Six studies, all at low risk of bias, were included: three RCTs and three non-RCTs (total of 27 TAVI, 99 SAVR and 129 mixed patients), with follow-up of 2-12 months. There was an increase in pooled exercise capacity (standardised mean difference: 0.41, 95% CI 0.11 to 0.70; moderate certainty evidence as assessed by GRADE), with exercise-based rehabilitation compared with control. Data on other outcomes including quality of life and clinical events were limited.

Conclusions: Exercise-based CR probably improves exercise capacity of post-TAVI and post-SAVR patients in the short term. Well conducted multicentre fully powered RCTs of ≥12 months follow-up are needed to fully assess the clinical and cost-effectiveness of exercise-based CR in this patient population.

Prospero protocol registration number: CRD42017084716.

Keywords: cardiac rehabilitation (cr); exercise-based cr; heart; surgical aortic valve replacement (savr); transcatheter aortic valve implantation (tavi).

Conflict of interest statement

Competing interests: LL is a coauthor on several Cochrane reviews. RT is an investigator on an ongoing programme of primary research in cardiac rehabilitation and is a coauthor on a number of Cochrane reviews of cardiac rehabilitation. All other authors report no relationships that could be construed as a conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing how studies were selected for this systematic review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plot of comparison: exercise versus no exercise, outcome: exercise capacity (VO2 max) at maximum follow-up, using a random-effects model stratified meta-analysis. RCTs, randomised controlled trials.
Figure 3
Figure 3
Forest plot of comparison: exercise versus no exercise, outcome: HRQoL (A) mental component (fixed-effects meta-analysis) and (B) physical component (random-effects meta-analysis). Overall, there is no statistically significant difference between both groups.

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