Application progress of pre-rehabilitation in patients undergoing transcatheter aortic valve replacement_West China Medical Journal

Authors：

HE Yaxie ¹ , XIAO Li ^1,2 , CHEN Mengshi ¹ , SU Yushuang ¹ ,  YANG Qin ^1,3

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, P. R. China;
2. Department of Geriatric Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;
3. Department of Intensive Care Units, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

YANG Qin, Email: 20152160@qq.com

Keywords：

Pre-rehabilitation; transcatheter aortic valve replacement; preoperative management

DOI：

10.7507/1002-0179.202402029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Pre-rehabilitation is an emerging preoperative management strategy designed to mitigate surgical stress responses and expedite postoperative recovery through optimized interventions, which typically includes exercise training, nutritional support, and psychological counseling. For patients undergoing transcatheter aortic valve replacement (TAVR), the implementation of pre-rehabilitation measures is particularly crucial. This article reviews the necessity and principal components of pre-rehabilitation in TAVR patients, and offers suggestions including constructing the best pre-rehabilitation intervention program for TAVR, enhancing patient compliance and engagement in the recovery process, and paying attention to the management of frailty for TAVR patients. The aim is to provide a reference for healthcare professionals seeking to further refine the pre-rehabilitation management model for TAVR patients.

Citation： HE Yaxie, XIAO Li, CHEN Mengshi, SU Yushuang, YANG Qin. Application progress of pre-rehabilitation in patients undergoing transcatheter aortic valve replacement. West China Medical Journal, 2024, 39(6): 970-975. doi: 10.7507/1002-0179.202402029 Copy

1.	Yang Y, Wang Z, Chen Z, et al. Current status and etiology of valvular heart disease in China: a population-based survey. BMC Cardiovasc Disord, 2021, 21(1): 339.
2.	中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
3.	毛越, 徐剑锋, 李梅, 等. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用. 中华护理杂志, 2022, 57(5): 563-569.
4.	Steinmetz C, Bjarnason-Wehrens B, Walther T, et al. Efficacy of prehabilitation before cardiac surgery: a systematic review and meta-analysis. Am J Phys Med Rehabil, 2023, 102(4): 323-330.
5.	Marmelo F, Rocha V, Moreira-Gonçalves D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: systematic review and meta-analysis. Eur J Prev Cardiol, 2018, 25(4): 404-417.
6.	曹晖, 陈亚进, 顾小萍, 等. 中国加速康复外科临床实践指南(2021 版). 中国实用外科杂志, 2021, 41(9): 961-992.
7.	Li C, Carli F, Lee L, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc, 2013, 27(4): 1072-1082.
8.	梁诗琪, 李婷婷, 任秋平, 等. 基于 ERAS 理念的预康复在腹部大手术病人中的应用研究进展. 护理研究, 2023, 37(18): 3335-3343.
9.	Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol, 2017, 70(6): 689-700.
10.	Komaki K, Yoshida N, Satomi-Kobayashi S, et al. Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement. Heart Vessels, 2021, 36(8): 1234-1245.
11.	Baimas-George M, Watson M, Elhage S, et al. Prehabilitation in frail surgical patients: a systematic review. World J Surg, 2020, 44(11): 3668-3678.
12.	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术后运动康复专家共识. 中国介入心脏病学杂志, 2020, 28(7): 361-368.
13.	Arora RC, Brown CH 4th, Sanjanwala RM, et al. “NEW” prehabilitation: a 3-way approach to improve postoperative survival and health-related quality of life in cardiac surgery patients. Can J Cardiol, 2018, 34(7): 839-849.
14.	沈佩烨, 兰岚, 王佳琪, 等. 老年心脏手术患者住院期间功能下降评估及影响因素研究进展. 中华护理杂志, 2023, 58(19): 2345-2352.
15.	DeCato TW, Haverkamp H, Hegewald MJ. Cardiopulmonary Exercise Testing (CPET). Am J Respir Crit Care Med, 2020, 201(1): P1-P2.
16.	《运动处方中国专家共识(2023)》专家组. 运动处方中国专家共识(2023). 中国运动医学杂志, 2023, 42(1): 3-13.
17.	刘佳霓, 李翔, 陈茂. 《经导管主动脉瓣置换术后运动康复专家共识》解读. 华西医学, 2021, 36(9): 1196-1200.
18.	Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next?. Anaesthesia, 2019, 74(Suppl 1): 20-26.
19.	Rogers P, Al-Aidrous S, Banya W, et al. Cardiac rehabilitation to improve health-related quality of life following trans-catheter aortic valve implantation: a randomised controlled feasibility study: RECOVER-TAVI Pilot, ORCA 4, for the Optimal Restoration of Cardiac Activity Group. Pilot Feasibility Stud, 2018, 4: 185.
20.	池蕾娟, 刘宏军, 杨超君, 等. 高强度间歇运动在急性冠状动脉综合征患者心脏康复中的研究进展. 中国医学科学院学报, 2023, 45(1): 149-154.
21.	罗泽汝心, 王渝强, 周亚馨, 等. 术前吸气肌训练预防成人心脏手术患者术后肺部并发症的最新进展. 中国胸心血管外科临床杂志, 2023, 30(10): 1519-1523.
22.	Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med, 2020, 54(24): 1451-1462.
23.	Zheng YT, Zhang JX. Preoperative exercise and recovery after cardiac surgery: a meta-analysis. BMC Cardiovasc Disord, 2020, 20(1): 2.
24.	Weber M, Klein U, Weigert A, et al. Use of pre- and intensified postprocedural physiotherapy in patients with symptomatic aortic stenosis undergoing transcatheter aortic valve replacement study (the 4P-TAVR Study). J Interv Cardiol, 2021, 2021: 8894223.
25.	Steinmetz C, Heinemann S, Kutschka I, et al. Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial. Trials, 2023, 24(1): 533.
26.	张临雪, 周家梅, 王菲, 等. 心脏手术病人术前衰弱评估与干预研究进展. 护理研究, 2023, 37(3): 449-454.
27.	Chermesh I, Hajos J, Mashiach T, et al. Malnutrition in cardiac surgery: food for thought. Eur J Prev Cardiol, 2014, 21(4): 475-483.
28.	Morimoto Y, Matsuo T, Yano Y, et al. Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery. J Phys Ther Sci, 2021, 33(3): 213-221.
29.	Jain SR, Kandarpa VL, Yaow CYL, et al. The role and effect of multimodal prehabilitation before major abdominal surgery: a systemic review and meta-analysis. World J Surg, 2023, 47(1): 86-102.
30.	陈丽芳, 曾洁文, 黄莲香, 等. 心脏瓣膜置换术后病人实施三联预康复的效果观察. 循证护理, 2023, 9(9): 1685-1688.
31.	吴春涛, 刘苏, 唐闽, 等. 心脏瓣膜病病人营养风险筛查及营养支持与术后临床结局的相关性分析. 肠外与肠内营养, 2019, 26(2): 104-108.
32.	Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr, 2004, 92(5): 799-808.
33.	Lomivorotov VV, Efremov SM, Boboshko VA, et al. Evaluation of nutritional screening tools for patients scheduled for cardiac surgery. Nutrition, 2013, 29(2): 436-442.
34.	Stoppe C, Goetzenich A, Whitman G, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care, 2017, 21(1): 131.
35.	叶绍东, 陈纪春, 刘鹏举, 等. 中国高龄患者心脏围术期营养评估专家共识. 中华老年心脑血管病杂志, 2023, 25(4): 361-367.
36.	Hoffer LJ, Bistrian BR. Appropriate protein provision in critical illness: a systematic and narrative review. Am J Clin Nutr, 2012, 96(3): 591-600.
37.	Chiang FY, Chen JR, Lee WJ, et al. Effects of milk or soy milk combined with mild resistance exercise on the muscle mass and muscle strength in very old nursing home residents with sarcopenia. Foods, 2021, 10(11): 2581.
38.	Zou J, Yuan J, Liu J, Geng Q. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. Front Cardiovasc Med, 2023, 10: 1164104.
39.	Goldfarb M, Lauck S, Webb JG, et al. Malnutrition and mortality in frail and non-frail older adults undergoing aortic valve replacement. Circulation, 2018, 138(20): 2202-2211.
40.	周雁荣, 张严丽, 罗亮春, 等. 叙事护理干预对心脏瓣膜置换术患者心理状态的影响. 护理学杂志, 2020, 35(21): 81-84.
41.	孙振晓, 刘化学, 焦林瑛, 等. 医院焦虑抑郁量表的信度及效度研究. 中华临床医师杂志(电子版), 2017, 11(2): 198-201.
42.	陈燕. 基于 5E 理念的预康复在心脏瓣膜置换术患者中的应用. 河南外科学杂志, 2021, 27(3): 103-104.
43.	刘然, 严婷婷, 陈琪, 等. 行经导管主动脉瓣置换术的主动脉瓣狭窄患者心脏康复实践与探索. 中国胸心血管外科临床杂志, 2022, 29(12): 1567-1573.
44.	刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022). 协和医学杂志, 2022, 13(3): 387-401.
45.	Naccarella L, Biuso C, Jennings A, et al. Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives. Aust Health Rev, 2019, 43(3): 323-327.
46.	马富珍, 刘长芬, 郑栋莲, 等. 心脏瓣膜置换术后患者Ⅰ期康复运动恐惧现状及影响因素分析. 当代护士(中旬刊), 2022, 29(10): 130-133.
47.	Hawkins MA, Dolansky MA, Levin JB, et al. Cognitive function and health literacy are independently associated with heart failure knowledge. Heart Lung, 2016, 45(5): 386-391.
48.	Marinus N, Vigorito C, Giallauria F, et al. Frailty is highly prevalent in specific cardiovascular diseases and females, but significantly worsens prognosis in all affected patients: a systematic review. Ageing Res Rev, 2021, 66: 101233.
49.	Hall DE, Arya S, Schmid KK, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg, 2017, 152(3): 233-240.
50.	Gard EK, Noaman S, Stub D, et al. The role of comorbidities in predicting functional improvement after transcatheter aortic valve implantation. Heart Lung Circ, 2024.
51.	Miyazaki T, Tanaka A, Tokuda Y, et al. The incidence and influencing factors of in-hospital frailty progression following transcatheter aortic valve implantation. Intern Med, 2024.
52.	王玮荻, 周雁荣, 陈小芹, 等. 老年衰弱病人围术期管理研究进展. 护理研究, 2020, 34(23): 4173-4176.

1. Yang Y, Wang Z, Chen Z, et al. Current status and etiology of valvular heart disease in China: a population-based survey. BMC Cardiovasc Disord, 2021, 21(1): 339.
2. 中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
3. 毛越, 徐剑锋, 李梅, 等. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用. 中华护理杂志, 2022, 57(5): 563-569.
4. Steinmetz C, Bjarnason-Wehrens B, Walther T, et al. Efficacy of prehabilitation before cardiac surgery: a systematic review and meta-analysis. Am J Phys Med Rehabil, 2023, 102(4): 323-330.
5. Marmelo F, Rocha V, Moreira-Gonçalves D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: systematic review and meta-analysis. Eur J Prev Cardiol, 2018, 25(4): 404-417.
6. 曹晖, 陈亚进, 顾小萍, 等. 中国加速康复外科临床实践指南(2021 版). 中国实用外科杂志, 2021, 41(9): 961-992.
7. Li C, Carli F, Lee L, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc, 2013, 27(4): 1072-1082.
8. 梁诗琪, 李婷婷, 任秋平, 等. 基于 ERAS 理念的预康复在腹部大手术病人中的应用研究进展. 护理研究, 2023, 37(18): 3335-3343.
9. Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol, 2017, 70(6): 689-700.
10. Komaki K, Yoshida N, Satomi-Kobayashi S, et al. Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement. Heart Vessels, 2021, 36(8): 1234-1245.
11. Baimas-George M, Watson M, Elhage S, et al. Prehabilitation in frail surgical patients: a systematic review. World J Surg, 2020, 44(11): 3668-3678.
12. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术后运动康复专家共识. 中国介入心脏病学杂志, 2020, 28(7): 361-368.
13. Arora RC, Brown CH 4th, Sanjanwala RM, et al. “NEW” prehabilitation: a 3-way approach to improve postoperative survival and health-related quality of life in cardiac surgery patients. Can J Cardiol, 2018, 34(7): 839-849.
14. 沈佩烨, 兰岚, 王佳琪, 等. 老年心脏手术患者住院期间功能下降评估及影响因素研究进展. 中华护理杂志, 2023, 58(19): 2345-2352.
15. DeCato TW, Haverkamp H, Hegewald MJ. Cardiopulmonary Exercise Testing (CPET). Am J Respir Crit Care Med, 2020, 201(1): P1-P2.
16. 《运动处方中国专家共识(2023)》专家组. 运动处方中国专家共识(2023). 中国运动医学杂志, 2023, 42(1): 3-13.
17. 刘佳霓, 李翔, 陈茂. 《经导管主动脉瓣置换术后运动康复专家共识》解读. 华西医学, 2021, 36(9): 1196-1200.
18. Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next?. Anaesthesia, 2019, 74(Suppl 1): 20-26.
19. Rogers P, Al-Aidrous S, Banya W, et al. Cardiac rehabilitation to improve health-related quality of life following trans-catheter aortic valve implantation: a randomised controlled feasibility study: RECOVER-TAVI Pilot, ORCA 4, for the Optimal Restoration of Cardiac Activity Group. Pilot Feasibility Stud, 2018, 4: 185.
20. 池蕾娟, 刘宏军, 杨超君, 等. 高强度间歇运动在急性冠状动脉综合征患者心脏康复中的研究进展. 中国医学科学院学报, 2023, 45(1): 149-154.
21. 罗泽汝心, 王渝强, 周亚馨, 等. 术前吸气肌训练预防成人心脏手术患者术后肺部并发症的最新进展. 中国胸心血管外科临床杂志, 2023, 30(10): 1519-1523.
22. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med, 2020, 54(24): 1451-1462.
23. Zheng YT, Zhang JX. Preoperative exercise and recovery after cardiac surgery: a meta-analysis. BMC Cardiovasc Disord, 2020, 20(1): 2.
24. Weber M, Klein U, Weigert A, et al. Use of pre- and intensified postprocedural physiotherapy in patients with symptomatic aortic stenosis undergoing transcatheter aortic valve replacement study (the 4P-TAVR Study). J Interv Cardiol, 2021, 2021: 8894223.
25. Steinmetz C, Heinemann S, Kutschka I, et al. Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial. Trials, 2023, 24(1): 533.
26. 张临雪, 周家梅, 王菲, 等. 心脏手术病人术前衰弱评估与干预研究进展. 护理研究, 2023, 37(3): 449-454.
27. Chermesh I, Hajos J, Mashiach T, et al. Malnutrition in cardiac surgery: food for thought. Eur J Prev Cardiol, 2014, 21(4): 475-483.
28. Morimoto Y, Matsuo T, Yano Y, et al. Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery. J Phys Ther Sci, 2021, 33(3): 213-221.
29. Jain SR, Kandarpa VL, Yaow CYL, et al. The role and effect of multimodal prehabilitation before major abdominal surgery: a systemic review and meta-analysis. World J Surg, 2023, 47(1): 86-102.
30. 陈丽芳, 曾洁文, 黄莲香, 等. 心脏瓣膜置换术后病人实施三联预康复的效果观察. 循证护理, 2023, 9(9): 1685-1688.
31. 吴春涛, 刘苏, 唐闽, 等. 心脏瓣膜病病人营养风险筛查及营养支持与术后临床结局的相关性分析. 肠外与肠内营养, 2019, 26(2): 104-108.
32. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr, 2004, 92(5): 799-808.
33. Lomivorotov VV, Efremov SM, Boboshko VA, et al. Evaluation of nutritional screening tools for patients scheduled for cardiac surgery. Nutrition, 2013, 29(2): 436-442.
34. Stoppe C, Goetzenich A, Whitman G, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care, 2017, 21(1): 131.
35. 叶绍东, 陈纪春, 刘鹏举, 等. 中国高龄患者心脏围术期营养评估专家共识. 中华老年心脑血管病杂志, 2023, 25(4): 361-367.
36. Hoffer LJ, Bistrian BR. Appropriate protein provision in critical illness: a systematic and narrative review. Am J Clin Nutr, 2012, 96(3): 591-600.
37. Chiang FY, Chen JR, Lee WJ, et al. Effects of milk or soy milk combined with mild resistance exercise on the muscle mass and muscle strength in very old nursing home residents with sarcopenia. Foods, 2021, 10(11): 2581.
38. Zou J, Yuan J, Liu J, Geng Q. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. Front Cardiovasc Med, 2023, 10: 1164104.
39. Goldfarb M, Lauck S, Webb JG, et al. Malnutrition and mortality in frail and non-frail older adults undergoing aortic valve replacement. Circulation, 2018, 138(20): 2202-2211.
40. 周雁荣, 张严丽, 罗亮春, 等. 叙事护理干预对心脏瓣膜置换术患者心理状态的影响. 护理学杂志, 2020, 35(21): 81-84.
41. 孙振晓, 刘化学, 焦林瑛, 等. 医院焦虑抑郁量表的信度及效度研究. 中华临床医师杂志(电子版), 2017, 11(2): 198-201.
42. 陈燕. 基于 5E 理念的预康复在心脏瓣膜置换术患者中的应用. 河南外科学杂志, 2021, 27(3): 103-104.
43. 刘然, 严婷婷, 陈琪, 等. 行经导管主动脉瓣置换术的主动脉瓣狭窄患者心脏康复实践与探索. 中国胸心血管外科临床杂志, 2022, 29(12): 1567-1573.
44. 刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022). 协和医学杂志, 2022, 13(3): 387-401.
45. Naccarella L, Biuso C, Jennings A, et al. Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives. Aust Health Rev, 2019, 43(3): 323-327.
46. 马富珍, 刘长芬, 郑栋莲, 等. 心脏瓣膜置换术后患者Ⅰ期康复运动恐惧现状及影响因素分析. 当代护士(中旬刊), 2022, 29(10): 130-133.
47. Hawkins MA, Dolansky MA, Levin JB, et al. Cognitive function and health literacy are independently associated with heart failure knowledge. Heart Lung, 2016, 45(5): 386-391.
48. Marinus N, Vigorito C, Giallauria F, et al. Frailty is highly prevalent in specific cardiovascular diseases and females, but significantly worsens prognosis in all affected patients: a systematic review. Ageing Res Rev, 2021, 66: 101233.
49. Hall DE, Arya S, Schmid KK, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg, 2017, 152(3): 233-240.
50. Gard EK, Noaman S, Stub D, et al. The role of comorbidities in predicting functional improvement after transcatheter aortic valve implantation. Heart Lung Circ, 2024.
51. Miyazaki T, Tanaka A, Tokuda Y, et al. The incidence and influencing factors of in-hospital frailty progression following transcatheter aortic valve implantation. Intern Med, 2024.
52. 王玮荻, 周雁荣, 陈小芹, 等. 老年衰弱病人围术期管理研究进展. 护理研究, 2020, 34(23): 4173-4176.

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