Association between comprehensive physical function before transcatheter aortic valve implantation and patient outcome.

This study aims to objectively and comprehensively assess preoperative physical function in patients undergoing TAVI and to investigate its association with postoperative patient outcomes. 

This study included 100 patients who underwent TAVI and postoperative rehabilitation at our institution between 2019 and March 2024. Rehabilitation was initiated on postoperative day 1 or 2 and was conducted for 40–60 minutes per session, at least five days a week. The length of hospital stay (LOS) following TAVI and functional decline during hospitalization, defined as hospital-associated disability (HAD) were evaluated. HAD was defined as a decrease of at least five points in the Barthel Index at discharge compared to the day before TAVI. Preoperative physical function was assessed using the Short Physical Performance Battery (SPPB). The SPPB is a physical function assessment consisting of three events: standing balance, walking speed, and a five-standing test. Patients were divided into two groups based on their SPPB scores: those with scores of 9 or higher, and those below 9. A comparative analysis of two groups and a multivariate regression analysis were performed. The dependent variables were LOS and incidence of HAD, while the independent variable was the preoperative SPPB score. Statistical significance was set at a p-value of less than 5%.

97 patients (median age 85.0 years, 62% female) met the inclusion criteria. The median LOS was 13 days, and the incidence of HAD was 30.1%. Comparative analysis between the two SPPB groups revealed no significant difference in the incidence of HAD (high SPPB group: 28%, low SPPB group: 33%; P=0.81). An important difference was observed in the LOS, with the high SPPB group exhibiting a shorter median stay (11.5 days) compared to the low SPPB group (14 days; P=0.02). In multivariate analysis, a higher preoperative SPPB score was independently associated with a shorter hospital stay (β: -0.5, 95% confidence interval: -0.93, -0.08, P0.02).

Our findings suggest that higher preoperative SPPB scores are associated with a shorter LOS following TAVI, indicating that preoperative comprehensive physical function plays a crucial role in postoperative recovery. However, pre-TAVI SPPB did not significantly impact the incidence of HAD, implying that while physical function is an important predictor of hospitalization duration, other factors may contribute to HAD. Further research is warranted to identify and validate these factors.

If the hypothesis of this study is proven, the importance of measuring SPPB before TAVI procedures will increase. It will also be increasingly recommended for use in clinical practice.