When should a patient start physical rehabilitation or exercises after a Transcatheter Aortic Valve Replacement (TAVR) procedure?

Physical Rehabilitation After TAVR: Timing and Approach

Patients should begin early mobilization as soon as the access site allows following TAVR procedure, with formal physical and occupational therapy assessment initiated prior to discharge. 1

Immediate Post-Procedure Mobilization

The American College of Cardiology expert consensus emphasizes the importance of early mobilization after TAVR:

• Day of procedure/Day 1: Begin mobilization as soon as the access site allows and hemodynamic stability is confirmed 1
• Initial activities: Start with sitting up, dangling legs at bedside, and progressing to standing and short walks with assistance
• Access site considerations:
  • Transfemoral approach: Mobilization typically begins within 4-24 hours after procedure
  • Transapical or transaortic approach: May require slightly delayed mobilization (24-48 hours) due to more invasive access

Structured Rehabilitation Timeline

1. Pre-discharge phase (typically days 1-3):

   • Physical and occupational therapy assessment should be initiated prior to discharge 1
   • Focus on basic mobility, transfers, and activities of daily living
   • Assess need for assistive devices or home modifications

2. Early post-discharge phase (first 30 days):

   • Follow-up with TAVR team at 30 days 1
   • Gradually increase walking distance and duration
   • Begin light household activities
   • Avoid heavy lifting (>10 pounds) during this period

3. Recovery phase (1-3 months):

   • Follow-up with primary care provider at 3 months 1
   • Progressive increase in activity as tolerated
   • Consider formal cardiac rehabilitation program

Evidence for Early Mobilization Benefits

Research demonstrates significant benefits of early and intensified physiotherapy for TAVR patients:

• A 2021 study showed that intensified physiotherapy reduced postinterventional pneumonia (5.1% vs 20.0%, p=0.016) and shortened hospital stays by 3 days (10.1 vs 13.5 days, p=0.02) 2
• Early mobilization contributes to improved outcomes and shorter hospital stays, with some centers now discharging patients within 2-4 days after TAVR under local anesthesia 3

Special Considerations

• Access site monitoring: Carefully observe for bleeding, hematoma, or pseudoaneurysm formation during early mobilization 1
• Pain management: Ensure appropriate pain control to facilitate mobility 1
• Antithrombotic therapy: Be aware of bleeding risk during rehabilitation activities, especially in patients on dual antiplatelet therapy (aspirin plus clopidogrel) 1
• Conduction abnormalities: Monitor for bradycardia or heart block during activity, especially in the first 30 days 1

Cardiac Rehabilitation Considerations

The ACC guidelines specifically mention cardiac rehabilitation as one of the basic principles for management after valve replacement:

• Formal cardiac rehabilitation programs may be beneficial, especially for patients with multiple comorbidities
• Focus on gradually increasing exercise capacity and promoting a healthy lifestyle
• Include education on risk factor modification and self-monitoring

Common Pitfalls to Avoid

1. Delayed mobilization: Waiting too long to mobilize increases risk of complications like pneumonia and deconditioning
2. Inadequate pain control: Poor pain management can limit mobility and rehabilitation progress
3. Overlooking comorbidities: Many TAVR patients are elderly with multiple health issues that may affect rehabilitation
4. Ignoring access site complications: Bleeding or hematoma formation can occur during early mobilization

By following this structured approach to rehabilitation after TAVR, patients can achieve optimal recovery while minimizing complications and improving long-term outcomes.