TAVI is a minimally invasive procedure used to replace the aortic valve, i.e., the heart valve between the left ventricle and the aorta. In a non-invasive and quick procedure a catheter is inserted into the patient, usually through the groin. The folded heart valve, which will be spread apart in the heart, rests on the catheter’s tip and replaces the old valve. This gentle procedure has so far been used with old and very ill patients. In their case, the risk of dying during a heart valve replacement surgery is too high. During this kind of surgery, the thorax is opened and a heart-lung machine is connected. Following a TAVI, the patients improve clinically rapidly and they are quickly mobile again. In the long term, a further advantage is that the patients do not have to take strong blood thinners.
Insufficient availability of data
The aim of the study conducted by the Munich scientists was to verify whether patients benefit from physical exercise following a TAVI. For although regular exercise is a fixed part of the aftercare and rehabilitation of patients with heart diseases, only few data on this subject are available for patients who underwent a heart valve replacement. “Particularly in elderly cardiac patients it is not a given fact that training of this kind always has a positive effect”, says Prof. Martin Halle, director of the Poliklinik für Präventive und Rehabilitative Sportmedizin, in whose team Preßler works. The researchers also wanted to verify, whether the inserted valves could bear the strain at all. Hence, they checked the performance of the heart valves regularly during the study with ultrasound scans, monitored the patients’ renal function, and examined blood values for indications of a heart failure.
Stationary bicycle and rowing machine prove effective
The study participants were divided into two groups: one training group that performed endurance and strength training with specific exercises for eight weeks, and one control group that did not receive structured training. “We were guided by currently recommended exercise programmes that have already proven successful in patients with other advanced cardiac diseases”, explains Preßler. In the first week, there were two workouts, after that the participants exercised three times a week. On their schedule were endurance training on a stationary bicycle and strength training on five different machines (e.g., rowing machine, leg and shoulder press machine). During the course of the study it became apparent that regular exercise was not a problem for the new heart valves; even under strain they operated flawlessly. Furthermore, after eight weeks the training group was fitter than the control group: the participants’ maximum oxygen uptake had risen and even their muscle strength had increased in all five tested muscle groups. Similarly, their quality of life had improved. The participants noted that in particular their physical abilities had improved; they now found everyday activities like walking, lifting, bending over, climbing stairs, and taking care of themselves easier. The training group even graded the symptoms of the disease as less strenuous after the eight weeks. “TAVI itself already improves the patients’ quality of life and physical fitness. Our pilot study now shows that subsequent physical exercise is safe, and enhances and expands the positive effects significantly”, Preßler summarizes the results. Now physicians not only utilize TAVI for high-risk patients, but also for less ill patients with a low or average surgical risk. New studies prove that TAVI is just as effective here as a surgical procedure.
Exercise Training Improves Exercise Capacity and Quality of Life after Transcatheter Aortic Valve Implantation: A Randomized Pilot Trial. Pressler, A., Christle, J. W., Lechner, B., Grabs, V., Haller, B., Hettich, I., Jochheim, D., Mehilli, J., Lange, R., Bleiziffer, S. & Halle, M. American heart journal 182, 44-53, (2016).
Priv.‑Doz. Dr. med. Axel Preßler, Zentrum für Prävention und Sportmedizin, Klinikum rechts der Isar, TU Munich, phone: +49 89 41406774, firstname.lastname@example.org
Christine Vollgraf, Public Relations Officer, German Centre for Cardiovascular Research (DZHK), phone: +49 30 3465 529 02, email@example.com
The German Centre for Cardiovascular Research (DZHK) wants to ensure that new knowledge from cardiovascular research reaches patients as quickly as possible. Our goal is to improve diagnosis, prevention, and treatment of cardiovascular diseases in Germany. In order to do this, basic research scientists and clinical scientists from 30 institutions work together at seven partner sites. The DZHK was founded in 2011 upon the initiative of the German Federal Ministry of Education and Research (BMBF) and is 90 percent funded by the Federal Government and 10 percent by the governments of those German federal states in which its member institutions are headquartered. It is among the six German Centres for Health Research (Deutsche Zentren der Gesundheitsforschung, DZG) that are dedicated to the investigation of widespread diseases.