Intensive physical therapy during the early postoperative period promotes recovery of physical function in frail patients after transcatheter aortic valve implantation

Abstract Background Physical frailty has been identified as a major prognostic factor in older patients undergoing transcatheter aortic valve implantation (TAVI). Previous studies have demonstrated that frailty predicts mortality, prolonged hospitalization, and readmission after TAVI. However, the influence of frailty on early postoperative recovery of physical function during hospitalization has not been sufficiently investigated. This study aimed to examine prospectively the association between preoperative frailty status and short-term postoperative changes in physical function among patients who underwent TAVI. Methods This retrospective observational study included consecutive patients with symptomatic severe aortic stenosis (AS) who were electively hospitalized for TAVI at our University Hospital between May 2018 and August 2025. Frailty was assessed one day before the TAVI using the Japanese version of the Cardiovascular Health Study criteria, which evaluates five domains: weight loss, exhaustion, physical activity, grip strength, and walking speed. Patients meeting three or more criteria were categorized as frail. Physical function was evaluated using the 6-minute walk distance (6MWD), usual gait speed, and the Short Physical Performance Battery (SPPB). Measurements were performed on the day before TAVI and again on postoperative day 7. Patients were divided into frail and non-frail groups based on the preoperative assessment. The primary outcome was the change in 6MWD between the two time points. Secondary outcomes included changes in gait speed and SPPB score. Between-group comparisons were conducted using t-tests and analysis of covariance adjusting for potential confounders, including age, sex, baseline physical function, and comorbidities. Results A total of 225 patients were analyzed (133 women, mean age 84.0 years). Preoperative frailty was identified in 101 patients (44.8%). Baseline physical function was significantly lower in the frail group compared with the non-frail group in terms of 6MWD, gait speed, and SPPB scores. The mean change in 6MWD as primary endpoint was -22 m in the non-frail group and +0.7 m in the frail group (P = 0.001). However, after adjustment for confounding factors, no statistically significant interaction between frailty status and changes in 6MWD was observed (interaction P = 0.220). Similarly, there were no significant interactions for gait speed (interaction P = 0.240) or SPPB (interaction P = 0.592). Conclusions Preoperative frailty was not associated with short-term changes in physical function after TAVI. Early intensive physical therapy following TAVI appeared to yield 6MWD improvement in favor of the frail group, but it showed no interaction for the outcome measures across frailty categories. These findings indicate that preoperative physical frailty does not modify the effect of early postoperative physical therapy following TAVI.