Usefulness of cardiac rehabilitation programs among older patients undergoing transcatheter aortic valve replacement: how should we do it?

Severe aortic stenosis has increased exponentially as a result of the aging of the population. Transcatheter aortic valve replacement (TAVR) procedures increase by 20%-30% per year in Spain. Referred patients are increasingly older, have comorbidities, and frailty. TAVR cardiac rehabilitation (CR) programs significantly improve both functional capacity and quality of life of patients. However, there are no guidelines on how to carry out them and few elderly patients are referred to CR. Furthermore, mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs. Multidisciplinary patient care, including comorbidities and frailty, is essential. It is necessary to ensure exquisite continuity of care during TAVR, CR, and the rest of the patient's life. Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR, given the high demand. This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.