Cardiac rehabilitation protocols outcome in frail patients undergoing transcatheter aortic valve implantation

The degenerative aortic stenosis (AS) is the most frequent valvular disease in the elderly (over 75 years), and its severe form is found in 12.4% associated with a low survival rate at 5 years (15-50%). These patients are categorised as frail and the only possible choice of treatment is transcatheter aortic valve implantation (TAVI). When cardiac rehabilitation programs (CRP) were introduced after TAVI, they had a positive impact on clinical outcome, increasing the quality of life and decreasing morbidity and mortality, especially in the elderly with high frailty score. This review underlines the utility of objective and functional frailty assessment in elderly patients with severe AS, before and after TAVI. Inclusion of these patients in complex and individually designed CRP could improve both QoL and short and long term outcome. Apart from exercise recommendation, a complete and ideal CRP should include nutrition counselling, occupational therapy, and psychological counselling to ensure psychosocial health, as well as social worker counselling. CRP could prevent and reduce severity of frailty by improving/increasing mobility, muscle mass and cognitive function. Further studies should aim at appraising long-term effects and prognostic relevance of CRP in frail patients undergoing TAVI.