Current evidence of perioperative rehabilitation nursing in frail elderly patients undergoing transcatheter aortic valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xiu ¹ , LUO Zeruxin ¹ , WANG Yuqiang ² , YU Pengming ¹ , LIU Lulu ² , LI Zhi ² ,  CHEN Miao ²

1. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

CHEN Miao, Email: 846260052@qq.com

Keywords：

Transcatheter aortic valve replacement; elderly valvular heart disease; frailty; perioperative period; prehabilitation; physical therapy; rehabilitation nursing; lifecycle management

DOI：

10.7507/1007-4848.202602053

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

The widespread adoption of transcatheter aortic valve interventions has profoundly reshaped surgical management, while simultaneously driving a paradigm shift in perioperative care for frail elderly patients. Existing evidence-based protocols derived from traditional open-heart surgery are increasingly inadequate for guiding the rehabilitation of this vulnerable population. This review synthesizes current evidence regarding perioperative rehabilitation for frail elderly patients undergoing transcatheter aortic valve replacement, focusing on frailty screening tools, preoperative prehabilitation, and early postoperative and home-based recovery protocols. The objective is to provide a standardized clinical framework for optimizing rehabilitation outcomes in this evolving field.

1.	國家心血管系統疾病醫療質量控制中心. 2024年中國心血管病醫療質量概述. 中國循環雜志, 2025, 40(7): 625-645.National Center for Cardiovascular Quality Improvement. Executive summary of the 2024 national report on the medical care quality of cardiovascular disease in China. Chin Circ J, 2025, 40(7): 625-645.
2.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
3.	Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
4.	Généreux P, Head SJ, Wood DA, et al. Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications. Eur Heart J, 2012, 33(19): 2388-2398.
5.	Amaki M, Moriwaki K, Nakai M, et al. Cost-effective analysis of transcatheter aortic valve replacement in patients with severe symptomatic aortic stenosis: a prospective multicenter study. J Cardiol, 2024, 83(3): 169-176.
6.	Chuang MY, Akodad M, Chatfield A, et al. Frailty assessment of transcatheter aortic valve replacement patients: contemporary practice and future directions. Struct Heart, 2021, 5(4): 357-366.
7.	Mori M, Gupta A, Wang Y, et al. Trends in transcatheter and surgical aortic valve replacement among older adults in the United States. J Am Coll Cardiol, 2021, 78(22): 2161-2172.
8.	Russo N, Compostella L, Tarantini G, et al. Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly. Eur J Prev Cardiol, 2014, 21(11): 1341-1348.
9.	Rodríguez-Ma?as L, Féart C, Mann G, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement. the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci, 2013, 68(1): 62-67.
10.	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.
11.	Niebauer J, B?ck C, Bischoff-Ferrari HA, et al. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol, 2024, 31(2): 146-181.
12.	Kim DH, Afilalo J, Shi SM, et al. Evaluation of changes in functional status in the year after aortic valve replacement. JAMA Intern Med, 2019, 179(3): 383-391.
13.	Solomon J, Moss E, Morin JF, et al. The essential frailty toolset in older adults undergoing coronary artery bypass surgery. J Am Heart Assoc, 2021, 10(15): e020219.
14.	James K, Baglini C, Schwartz AW. From the ground up: recognising risk of frailty syndromes and functional decline through foot examination. BMJ Case Rep, 2021, 14(5): e236229.
15.	Katano S, Kono Y, Yano T, et al. Impact of in-hospital cardiac rehabilitation on hospital-associated disability after transcatheter aortic valve implantation. J Am Geriatr Soc, 2025, 73(2): 506-519.
16.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
17.	Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: the 3M TAVR study. JACC Cardiovasc Interv, 2019, 12(5): 459-469.
18.	Lauck SB, Sathananthan J, Park J, et al. Post-procedure protocol to facilitate next-day discharge: results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv, 2020, 96(2): 450-458.
19.	Lauck SB, Yu M, Bancroft C, et al. Early mobilization after transcatheter aortic valve implantation: observational cohort study. Eur J Cardiovasc Nurs, 2024, 23(3): 296-304.
20.	Kirk BH, N?rgaard MW, Palm P, et al. Safety and patient experience with early mobilization after transcatheter aortic valve implantation: a randomized trial. J Cardiovasc Nurs, 2025, 40(5): e231-e238.
21.	Vendrik J, Vlastra W, van Mourik MS, et al. Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J, 2020, 28(5): 240-248.
22.	Young MN, Inglessis I. Transcatheter aortic valve replacement: outcomes, indications, complications, and innovations. Curr Treat Options Cardiovasc Med, 2017, 19(10): 81.
23.	Chamandi C, Abi-Akar R, Rodés-Cabau J, et al. Transcarotid compared with other alternative access routes for transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2018, 11(11): e006388.
24.	Elbadawi A, Mohamed AH, Elgendy IY, et al. Comparative outcomes of transapical versus transfemoral access for transcatheter aortic valve replacement in diabetics. Cardiol Ther, 2020, 9(1): 107-118.
25.	Ochani S, Adnan A, Siddiqui A, et al. Postoperative delirium in47 379 individuals undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Ann Med Surg (Lond), 2023, 85(9): 4476-4490.
26.	Ma X, Chu H, Han K, et al. Postoperative delirium after transcatheter aortic valve replacement: an updated systematic review and meta-analysis. J Am Geriatr Soc, 2023, 71(2): 646-660.
27.	Mauri V, Reuter K, K?rber MI, et al. Incidence, risk factors and impact on long-term outcome of postoperative delirium after transcatheter aortic valve replacement. Front Cardiovasc Med, 2021, 8: 645724.
28.	Mach M, Okutucu S, Kerbel T, et al. Vascular complications in TAVR: incidence, clinical impact, and management. J Clin Med, 2021, 10(21): 5046.
29.	Gebhardt BR, Jain A, Basaham SA, et al. Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement. Ann Card Anaesth, 2019, 22(3): 239-245.
30.	Mousa Basha M, Al-Kassou B, Gestrich C, et al. Microbial growth on temporary pacemaker leads post-TAVR: pathogen spectrum and clinical implications. Clin Res Cardiol, 2024. Epub ahead of print. PMID: 39256220.
31.	Damluji AA, Bernacki G, Afilalo J, et al. TAVR in older adults: moving toward a comprehensive geriatric assessment and away from chronological age: JACC Family series. JACC Adv, 2024, 3(4): 100877.
32.	He J. Prognostic value of sarcopenia in aortic valve replacement: a systematic review and meta-analysis. Front Nutr, 2025, 12: 1529270.
33.	Onishi S, Kuwahara T, Tajika M, et al. Artificial intelligence for body composition assessment focusing on sarcopenia. Sci Rep, 2025, 15(1): 1324.
34.	Schattinger CM, Newlin-Bradner MK, Kviatkovsky SA, et al. A pilot study in transcatheter aortic valve replacement patients to examine the effects of resistance training and protein supplementation through telehealth. J Aging Phys Act, 2025, 34(2): 169-182.
35.	El-Sabawi B, Cloud H, Patel JN, et al. Association of depression and cognitive dysfunction with patient-centered outcomes after transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2023, 16(8): e012875.
36.	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.
37.	Oz A, Tsoumas I, Lampropoulos K, et al. Cardiac rehabilitation after TAVI: a systematic review and meta-analysis. Curr Probl Cardiol, 2023, 48(3): 101531.
38.	Krishnaswamy A, Isogai T, Agrawal A, et al. Feasibility and safety of same-day discharge following transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2022, 15(6): 575-589.
39.	Barbanti M. Early discharge after transcatheter aortic valve replacement: mature times. JACC Cardiovasc Interv, 2019, 12(5): 431-432.

1. 國家心血管系統疾病醫療質量控制中心. 2024年中國心血管病醫療質量概述. 中國循環雜志, 2025, 40(7): 625-645.National Center for Cardiovascular Quality Improvement. Executive summary of the 2024 national report on the medical care quality of cardiovascular disease in China. Chin Circ J, 2025, 40(7): 625-645.
2. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
3. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
4. Généreux P, Head SJ, Wood DA, et al. Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications. Eur Heart J, 2012, 33(19): 2388-2398.
5. Amaki M, Moriwaki K, Nakai M, et al. Cost-effective analysis of transcatheter aortic valve replacement in patients with severe symptomatic aortic stenosis: a prospective multicenter study. J Cardiol, 2024, 83(3): 169-176.
6. Chuang MY, Akodad M, Chatfield A, et al. Frailty assessment of transcatheter aortic valve replacement patients: contemporary practice and future directions. Struct Heart, 2021, 5(4): 357-366.
7. Mori M, Gupta A, Wang Y, et al. Trends in transcatheter and surgical aortic valve replacement among older adults in the United States. J Am Coll Cardiol, 2021, 78(22): 2161-2172.
8. Russo N, Compostella L, Tarantini G, et al. Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly. Eur J Prev Cardiol, 2014, 21(11): 1341-1348.
9. Rodríguez-Ma?as L, Féart C, Mann G, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement. the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci, 2013, 68(1): 62-67.
10. 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.
11. Niebauer J, B?ck C, Bischoff-Ferrari HA, et al. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol, 2024, 31(2): 146-181.
12. Kim DH, Afilalo J, Shi SM, et al. Evaluation of changes in functional status in the year after aortic valve replacement. JAMA Intern Med, 2019, 179(3): 383-391.
13. Solomon J, Moss E, Morin JF, et al. The essential frailty toolset in older adults undergoing coronary artery bypass surgery. J Am Heart Assoc, 2021, 10(15): e020219.
14. James K, Baglini C, Schwartz AW. From the ground up: recognising risk of frailty syndromes and functional decline through foot examination. BMJ Case Rep, 2021, 14(5): e236229.
15. Katano S, Kono Y, Yano T, et al. Impact of in-hospital cardiac rehabilitation on hospital-associated disability after transcatheter aortic valve implantation. J Am Geriatr Soc, 2025, 73(2): 506-519.
16. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
17. Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: the 3M TAVR study. JACC Cardiovasc Interv, 2019, 12(5): 459-469.
18. Lauck SB, Sathananthan J, Park J, et al. Post-procedure protocol to facilitate next-day discharge: results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv, 2020, 96(2): 450-458.
19. Lauck SB, Yu M, Bancroft C, et al. Early mobilization after transcatheter aortic valve implantation: observational cohort study. Eur J Cardiovasc Nurs, 2024, 23(3): 296-304.
20. Kirk BH, N?rgaard MW, Palm P, et al. Safety and patient experience with early mobilization after transcatheter aortic valve implantation: a randomized trial. J Cardiovasc Nurs, 2025, 40(5): e231-e238.
21. Vendrik J, Vlastra W, van Mourik MS, et al. Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J, 2020, 28(5): 240-248.
22. Young MN, Inglessis I. Transcatheter aortic valve replacement: outcomes, indications, complications, and innovations. Curr Treat Options Cardiovasc Med, 2017, 19(10): 81.
23. Chamandi C, Abi-Akar R, Rodés-Cabau J, et al. Transcarotid compared with other alternative access routes for transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2018, 11(11): e006388.
24. Elbadawi A, Mohamed AH, Elgendy IY, et al. Comparative outcomes of transapical versus transfemoral access for transcatheter aortic valve replacement in diabetics. Cardiol Ther, 2020, 9(1): 107-118.
25. Ochani S, Adnan A, Siddiqui A, et al. Postoperative delirium in47 379 individuals undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Ann Med Surg (Lond), 2023, 85(9): 4476-4490.
26. Ma X, Chu H, Han K, et al. Postoperative delirium after transcatheter aortic valve replacement: an updated systematic review and meta-analysis. J Am Geriatr Soc, 2023, 71(2): 646-660.
27. Mauri V, Reuter K, K?rber MI, et al. Incidence, risk factors and impact on long-term outcome of postoperative delirium after transcatheter aortic valve replacement. Front Cardiovasc Med, 2021, 8: 645724.
28. Mach M, Okutucu S, Kerbel T, et al. Vascular complications in TAVR: incidence, clinical impact, and management. J Clin Med, 2021, 10(21): 5046.
29. Gebhardt BR, Jain A, Basaham SA, et al. Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement. Ann Card Anaesth, 2019, 22(3): 239-245.
30. Mousa Basha M, Al-Kassou B, Gestrich C, et al. Microbial growth on temporary pacemaker leads post-TAVR: pathogen spectrum and clinical implications. Clin Res Cardiol, 2024. Epub ahead of print. PMID: 39256220.
31. Damluji AA, Bernacki G, Afilalo J, et al. TAVR in older adults: moving toward a comprehensive geriatric assessment and away from chronological age: JACC Family series. JACC Adv, 2024, 3(4): 100877.
32. He J. Prognostic value of sarcopenia in aortic valve replacement: a systematic review and meta-analysis. Front Nutr, 2025, 12: 1529270.
33. Onishi S, Kuwahara T, Tajika M, et al. Artificial intelligence for body composition assessment focusing on sarcopenia. Sci Rep, 2025, 15(1): 1324.
34. Schattinger CM, Newlin-Bradner MK, Kviatkovsky SA, et al. A pilot study in transcatheter aortic valve replacement patients to examine the effects of resistance training and protein supplementation through telehealth. J Aging Phys Act, 2025, 34(2): 169-182.
35. El-Sabawi B, Cloud H, Patel JN, et al. Association of depression and cognitive dysfunction with patient-centered outcomes after transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2023, 16(8): e012875.
36. 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.
37. Oz A, Tsoumas I, Lampropoulos K, et al. Cardiac rehabilitation after TAVI: a systematic review and meta-analysis. Curr Probl Cardiol, 2023, 48(3): 101531.
38. Krishnaswamy A, Isogai T, Agrawal A, et al. Feasibility and safety of same-day discharge following transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2022, 15(6): 575-589.
39. Barbanti M. Early discharge after transcatheter aortic valve replacement: mature times. JACC Cardiovasc Interv, 2019, 12(5): 431-432.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesCurrent evidence of perioperative rehabilitation nursing in frail elderly patients undergoing transcatheter aortic valve replacement

Abstract Full text Figures/Tables Video References Cited by

Format

Content