The effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing TAVR

The effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing TAVR | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing TAVR Yanxin Song, Haiyan Zheng, Chuan Ren, Wei Zhao, Jinan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6539160/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To explore the effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing transcatheter aortic valve replacement (TAVR) . Method Following the initiation of the trial, 29 patients who received TAVR were prospectively enrolled as the intervention group, and 29 patients who received TAVR were retrospectively enrolled as the control group. The control group patients received routine treatment and nursing care after admission. Besides routine treatment and nursing care, a perioperative cardiopulmonary integrated rehabilitation program was carried out for the interventional group after admission. Patients’ incidence of postoperative dyspnea, fever, infection, etc.; postoperative physical activity status and duration of hospitalization; exercise capacity and exercise adherence 1 month after discharge; exercise adherence 3 months after discharge were compared between the two groups. Result No adverse events occurred in all patients. Compared with the control group, the intervention group had lower incidence of dyspnea and fever (P < 0.05), significantly shorter postoperative length of CCU residence and bed rest time (P < 0.05), better physical activity status and exercise capacity, and higher exercise adherence after discharge (P < 0.05). Conclusion The perioperative cardiopulmonary integrated rehabilitation in TAVR patients is safe and effective. Cardiac rehabilitation Cardiopulmonary integrated rehabilitation Aortic stenosis Aortic regurgitation Transcatheter aortic valve replacement Figures Figure 1 Introduction Heart valve disease is a common type of cardiovascular disease. Transcatheter aortic valve replacement (TAVR) is a new method for treating patients with aortic stenosis (AS) or aortic regurgitation (AR) in recent years [ 1 – 3 ] . At present, the majority of patients receiving TAVR are elderly, with multiple comorbidities and poor physical condition. These patients have a higher likelihood of developing complications, such as pulmonary infection and deep vein thrombosis in the lower limbs during hospitalization. Preoperative and postoperative rehabilitation treatment for these patients can reduce the occurrence of these complications [ 4 , 5 ] . Consensus among experts in Europe, America, and China recommends early initiation of rehabilitation before and after TAVR surgery [ 6 – 8 ] . At present, the cardiac rehabilitation of TAVR patients in China is still in its early stage, mostly initiated after surgery [ 4 ] , and more emphasis is placed on exercise rehabilitation. Respiratory rehabilitation is not completely included in the entire rehabilitation process [ 9 ] , and there is a lack of unified exercise programs, and no systematic evaluation methods to evaluate the effects of rehabilitation. This article introduces the program and effects of perioperative cardiopulmonary integrated rehabilitation for TAVR patients at Peking University Third Hospital, providing evidence for the improvement of the cardiac rehabilitation model for Chinese TAVR patients. Data and Methods Information From January to August 2022, 29 patients who received TAVR were retrospectively enrolled as the control group, and from September 2022 to May 2024, 29 patients who were scheduled to recieve TAVR were prospectively enrolled as the intervention group. This study has been approved by the Medical Ethics Committee of Peking University Third Hospital (Approval No.: M2021321). Both the patient and their family members provided informed consent. Inclusion criteria Inclusion criteria were the following: diagnosed with degenerative aortic disease before surgery, no mental illness or functional impairment, without serious complications after surgery, consciousness, informed consentation. Exclusion criteria Exclusion criteria were as follows: undergoing emergency valve replacement surgery; undergoing cardiac re-surgery; severe functional impairment of important organs such as lungs, liver, and kidneys before surgery; unable to take care of oneself; unable to take part in cardiac rehabilitation; died within 72 hours after surgery. Method Intervention The control group patients received routine treatment and nursing care during hospitalization. Besides routine treatment and nursing, the interventional group recieved a perioperative cardiopulmonary integrated rehabilitation program after admission [ 6 , 10 , 11 ] . The program included ⑴ preoperative evaluation: collecting patients’ detailed medical history; evaluating the patients’ preoperative valve function of the structural heart disease, EuroSCORE score, New York Heart Association heart function classification, functional evaluation of important organs such as heart, lung, brain, and kidney; examining factors related to exercise such as motor system and nervous system factors (muscle strength, joint mobility, coordination function, balance capacity, etc.); evaluating patients’ daily exercise habits and exercise volume, frailty, nutritional status, cognitive function, psychological state, quality of life, and activities of daily living. ⑵ Preoperative rehabilitation education and comprehensive rehabilitation program including medication, exercise, nutrition, psychology, sleep, and smoking cessation before and after surgery. ⑶ Preoperative cardiopulmonary rehabilitation: contracted lips breath and abdominal breath were used to improve respiratory function, guiding patients to effectively cough; the large muscle groups of the upper and lower limbs exercising to enhance muscle strength, and maintain consistent breathing and limbs movement during the exercise process; walking training and taking stationary steps to enhance cardioulmonary endurance, while maintaining a steady breathing rate during exercise. According to the patient's tolerance, the rehabilitation duration continued 20–30 minutes, 1–2 times a day. ⑷ Early postoperative rehabilitation assessment: after TAVR surgery, patients could enter the intensive care unit, when their vital signs kept stable, they could undergo early postoperative rehabilitation assessment, including puncture site, catheterization, mental state, communicational ability, muscle strength assessment, pain assessment, and limbs mobility. ⑸ Postoperative cardiopulmonary rehabilitation: During bed rest stage, changing patients’ posture, helping patients’ turn over, limb activities locally(passive and auxiliary moving when patients were not awake; therapist assisted or patient actively exercising when patients were awake, keeping breathing and movement consistent), respiratory rehabilitation, coughing and sputum discharge training; limb training, standing balance, walking, and coordinated training. According to the patient's tolerance, the rehabilitation duration continued 30–40 minutes each time, twice a day. During the rehabilitation process, closely monitor the patient's vital signs. If the patient experienced ① new onset of arrhythmia, ② ST segment changes on electrocardiogram, ③ dyspnea, ④ obvious fatigue intolerance, the rehabilitation program must be stopped, and give the patient medical treatment. Researchers recorded the patients’ activities of daily living (Barthel Index) at admission and discharge. Before the patients discharge, researchers instructed patients to perform a 6-minute walking test(6-MWT) to assess patients’ exercise capacity, and provided rehabilitation guidance based on their 6-MWT results. Researchers regularly monitored the exercise of interventional group patients through WeChat. At the 1-month follow-up, researchers evaluated all patients’ exercise adherence and retest their 6-MWT. Researchers conducted a telephone survey on the patient's exercise adherence 3 months after discharge. Evaluation indicators Patients’ incidence of postoperative respiratory distress (Borg respiratory distress score), fever, infection, etc.; postoperative physical activity status of patients; patients’ exercise capacity and exercise adherence 1 month after discharge; patient's exercise adherence 3 months after discharge. Statistics Using SPSS 25.0 statistical software for analysis, normality test and homogeneity of variance test were performed first. Normally distributed measurement data were expressed as mean ± standard deviation (x ± s) and independent sample t-test was used. Non-normally distributed measurement data were expressed as median and interquartile range [M (Q25, Q75)] and non-parametric test were used. The enumeration data were expressed as percentages and chi square test was used. P < 0.05 was considered statistically significant. Results Baseline data There were no statistically significant differences in height, weight, BMI, age, gender, comorbidities, preoperative cardiac function, type of valve disease, valve surgery risk, medication use, and activities of daily living(ADL, Barthel index) between the two groups of patients(P > 0.05) (Table 1 ). 3.2 Rehabilitation Effects Comparison of occurrence of postoperative dyspnea, fever and infection between the two groups is shown in Tables 2 and 3 . The incidence of dyspnea and fever in the intervention group was significantly lower than that in the control group(P = 0.028 and P = 0.033, respectively). No interventional patient showed sever dyspnea. No adverse events occurred during the rehabilitation process of all patients. Patients’ duration of hospitalization and physical activity of the two groups is shown in Table 4 . The intervention group exhibited significantly shorter postoperative bed rest duration and CCU hospitalization duration compared to the control group, with a statistically significant difference(P = 0 and P = 0.042, respectively). Furthermore, while the intervention group showed better performance in postoperative hospital stay length and daily living activities than the control group, no statistically significant difference was observed. Additionally, the 6-MWT at discharge was significantly longer in the intervention group versus the control group(135.65 ± 35.39 vs. 165.71 ± 44.74, P = 0.030). When the patient came to the hospital for a follow-up 1 month after discharge, the patient's 6-MWT was retested and their exercise habits were investigated. Patients in the intervention group demonstrated significantly better exercise adherence and 6-MWT compared to the control group. See Table 5 . After 3 months of discharge, telephone follow-up was conducted on the patient's exercise adherence. The superiority in exercise adherence persisted in the intervention group at 3 months post-discharge when compared with controls(P = 0.033). See Table 6 . Discussion Since 2002, TAVR has undergone more than 20 years of development, and its safety and efficacy have been confirmed by multiple large-scale, multicenteral, prospective, randomized controlled trials, as well as clinical registration studies, gradually expanding its indications to low-risk patients [ 1 – 3 ] . However, the current rehabilitation work for TAVR patients is still incomplete, with studies showing that less than 1 in 3 patients take part in cardiac rehabilitation, which is mostly the outpatient rehabilitation [ 12 , 13 ] . This study is based on the experience and guidelines of TAVR rehabilitation in China and abroad [ 6 , 7 , 9 ] . According to the physiological characteristics of the heart and lungs [ 10 ] , we carried out perioperative cardiopulmonary integrated rehabilitation for TAVR patients in our hospital, and appoved its efficiency. The mian findings are as follows: Perioperative cardiopulmonary integrated rehabilitation can shorten TAVR patients’ postoperative bed rest time, length of CCU residence; improve patients’ physical activity status. Perioperative cardiopulmonary integrated rehabilitation can reduce TAVR patients’ incidence of postoperative complications (such as dyspnea and fever). Perioperative rehabilitation and regular follow-up can improve TAVR patients’ exercise adherence and prolong the rehabilitation effects after discharge. Perioperative cardiopulmonary integrated rehabilitation improve TAVR patients’ physical activity status Perioperative rehabilitation has been well-established in surgical patients and currently, there is evidence of TAVR perioperative rehabilitation [ 5 , 6 , 9 , 11 ] . However, there are still a large number of TAVR patients just take part in rehabilitation program after surgery [ 4 , 14 ] , often ignore prerehabilitation [ 15 , 16 ] . In this study, the staff conducted prerehabilitation evaluation and intervention for TAVR patients, and provided them with a certain understanding of the surgery through preoperative education. Cardiopulmonary rehabilitation training before surgery can improve patients' cardiopulmonary function and ADL [ 5 , 6 , 9 , 10 , 15 , 16 ] , allowing them to prepare for surgery from both psychological and physiological aspects. In addition, Steinmetz’s study has shown that preoperative rehabilitation can improve patients' 6-minute walking distance after surgery [ 15 ] . After patients return to the cardiac intensive care unit after surgery and their vital signs are stable, the postoperative rehabilitation begins as soon as possible. As early as 2010, the updated guidelines of the American Heart and Lung Association/American Heart Association clearly stated that early exercise rehabilitation can help patients regain mobility and self-care ability quickly [ 17 ] , and be discharged quickly [ 18 ] . Obafemi’s study has shown that cardiopulmonary integrated rehabilitation could reduce patients’ mean length of ICUand hospital stay by 1–3 days and 1–7 days, respectively [ 19 ] . We got the similar results in our study. The average postoperative bed rest time of interventional patients in our study was 1.47 days, which was significantly shorter than the control group and other study [ 20 ] . What’s more, the interventional patients’ exercise capacity was better than the control patients(6-MWT: 165.71 ± 44.74 vs. 135.65 ± 35.39, P = 0.030). Perioperative cardiopulmonary integrated rehabilitation reduce TAVR patients’ incidence of postoperative complications Previous study has shown that cardiopulmonary integrated rehabilitation could reduce bronchopneumonia rate from 18.8 to 9.7% in patients undergoing CABG [ 21 ] . Moreover, Hui’s study showed that cardiopulmonary integrated rehabilitation could also be applied to patients with heart failure, and individualized rehabilitation training significantly improved patients’6-MWT and the SF-36 score [ 10 ] . Patients who receive TAVR are mostly elderly, weak, and have multiple chronic diseases. In this study, 34.5% of the intervention group had chronic lung disease, and nearly 1/4 of the patients had heart failure. Cardiopulmonary integrated rehabilitation not only improves patients' cardiopulmonary endurance, but also enhanced the endurance of respiratory muscles, established effective breathing patterns, alleviated dyspnea, ensured effective ventilation and cough, and reduced the occurrence of postoperative pulmonary complications [ 5 , 6 , 9 , 22 ] . In this study, the incidence of fever, dyspnea, and degree of dyspnea of the intervention group were lower than that of the control group. Kleczynski's study [ 14 ] found that although participation in rehabilitation during hospitalization can improve patients' clinical status and quality of life, the probability of patients participating in cardiac rehabilitation decreases after discharge, it was the same in our study. Desai believe that patients who have participated in cardiac rehabilitation programs are more likely to adhere to cardiac rehabilitation [ 13 ] , while Oz's systematic review suggests the need to encourage TAVR patients to regularly participate in cardiac rehabilitation after discharge [ 4 ] . The rehabilitation program of this study made patients aware of the significance of cardiopulmonary rehabilitation during hospital, and conducted regular telephone follow-up after patients discharge to promote them to take part in regular cardiac rehabilitation outside the hospital. 75.6% and 72.4% of patients in the interventional group exercised regularly after 1 month and 3 months discharge respectively, which were significantly higher than that in the control group (P = 0.008 and P = 0.033, respectively). Perioperative rehabilitation and regular follow-up improve TAVR patients’ exercise adherence and prolong the rehabilitation effects It is important to note that This study is the first investigation to apply cardiopulmonary integration rehabilitation among Chinese perioperative patients undergoing TAVR, and demonstrated its efficacy in reducing postoperative complications and enhancing postoperative mobility. However, the study has limitations, including a limited sample size and a non-randomized controlled trial design. Therefore, larger-scale randomized controlled trials may well be considered to further explore more effective rehabilitation methods. Conclusion Perioperative cardiopulmonary integrated rehabilitation for TAVR patients can reduce the occurrence of complications, promote early mobilization and discharge, improve exercise capacity, and restore daily life. Early rehabilitation in hospital and regular follow-up can help patients adhere to rehabilitation program after discharge, prolong rehabilitation benefits, improve quality of life, and have high health and socio-economic value. Declarations Data Availability Statement: The authors confirm that the data supporting the findings of this study are available within the article. Authors' Contributions: SYX: Study design, data analysis, and writing the original draft. ZHY, WJN: Paper screening and data extraction. RC, ZW: Quality assessment, and writing-review. All authors contributed to the article and approved the submitted version. Conflict of Interest: The authors declare that they have no conflict of interest. Ethics statement: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. Funding: Youth Incubation Fund of Peking University Third Hospital (BYSYFY2021013), Clinical Key Project of Peking University Third Hospital (BYSYFZD2021008), Research Project of Beijing Chronic Disease Prevention and Health Education Research Association (BJMB0012021025025). References Structural Cardiology Professional Committee of the Cardiovascular Physicians Branch of the Chinese Medical Association. 2021 Expert consensus on clinical pathway for transcatheter aortic valve replacement in China[J]. Chinese Circulation Journal, 2022, 37(1): 12–23. doi: 10.3969/j.issn.1000-3614.2022.01.003 . Isogai T, Saad A M, Ahuja K R, et al. Short-term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States[J]. Catheter Cardiovasc Interv, 2021,97(3): 477–485. doi: 10.1002/ccd.29189 . Damluji A A, Bernacki G, Afilalo J, et al. 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Tables Table 1 Comparison of baseline data between the two groups of patients Control Group number (%)/mean ± S Intervention Group number (%)/mean ± S t/χ 2 P AS 21(72.4) 23(79.3) 0.377 0.539 Male 17(58.6) 19(65.5) 0.293 0.588 Hypertension 22(75.9) 19(65.5) 0.749 0.387 Hyperlipidemia 9(31.0) 11(37.9) 0.305 0.581 Diabetes mellitus 11(37.9) 8(27.6) 0.704 0.401 Coronary heart disease 16(55.2) 20(69) 1.172 0.274 Hyperuricemia 0(0.0) 2(6.9) 0.518 0.472 Chronic lung disease 5(17.2) 10(34.5) 2.248 0.134 Heart failure 6(20.7) 7(24.1) 0.099 0.753 Acute myocardial infarction 3(10.3) 3(10.3) 0.000 1 Age 73.67 ± 9.07 74.69 ± 8.03 -0.322 0.749 Height(cm) 165.21 ± 9.87 164.34 ± 8.94 0.349 0.729 Weight (kg) 66.21 ± 10.85 65.93 ± 14.52 0.082 0.935 BMI 24.15 ± 2.67 24.16 ± 3.54 -0.008 0.994 LVEDD 52.68 ± 10.26 55.16 ± 10.73 -0.900 0.372 LVESD 33.86 ± 10.23 38.55 ± 12.75 -1.544 0.128 LAP 16.64 ± 7.25 16.54 ± 5.78 0.058 0.954 PASP 38.95 ± 17.27 37.64 ± 14.27 0.273 0.786 LVEF 63.90 ± 10.18 57.52 ± 15.43 1.859 0.069 Hgb 128.45 ± 1.89 130.07 ± 18.99 -0.388 0.700 Blood glucose (mmol/L) 5.83 ± 1.26 5.62 ± 0.90 0.732 0.468 Albumin 39.65 ± 4.27 39.70 ± 3.85 -0.048 0.962 Scr (µmol/L) 95.31 ± 45.73 105.48 ± 78.49 -0.603 0.549 EuroSCORE 6.45 ± 4.18 8.03 ± 3.27 -1.612 0.113 NT-proBNP 526(188.50,1955.00) 1451(213.00,4420.50) 0.155 Βeta-blocker 14(48.3) 10(34.5) 1.137 0.286 ACEI 4(13.8) 3(10.3) 0.000 1.000 ARB 14(48.3) 17(58.6) 0.624 0.430 Statin 22(75.9) 22(75.9) 0.000 1.000 Diuretics 18(62.1) 21(72.4) 0.704 0.401 Barthel index 72.24 ± 26.85 69.66 ± 23.56 0.390 0.698 AS, Aortic stenosis; BMI, Body mass index; LVEDD, Left ventricular end-diastolic dimension; LVESD, Left ventricular end-systolic dimension; LAP, Left atrial pressure; PASP, Pulmonary arterial systolic pressure; LVEF, Left ventricular ejection fractio; Hgb, Hemoglobin; EuroSCORE, European System for Cardiac Operative Risk Evaluation; NT-proBNP, N-terminal pro brain natriuretic peptide; ACEI, Angiotensin converting enzyme inhibitors; ARB, Angiotensin II receptor blockage. Table 2 Comparison of incidence of postoperative dyspnea, fever, and infection between the two groups Control Group number (%) Intervention Group number (%) χ 2 P Dyspnea 10(34.5) 3(10.3) 4.858 0.028 Fever 16(55.2) 8(27.6) 4.549 0.033 Infection 10(34.5) 5(17.2) 2.248 0.134 Table 3 Degree of dyspnea between the two groups Control Group number (%) Intervention Group number (%) No dyspnea 19(65.5) 26(89.7) Mild dyspnea 4(13.8) 1(3.4) Moderate dyspnea 5(17.2) 2(6.9) Severe dyspnea 1(3.4) 0(0.0) Table 4 Comparison of postoperative hospitalization and physical activity of patients Control Group mean ± S Intervention Group mean ± S T P Postoperative length of CCU residence 4.00 ± 2.33 2.93 ± 1.49 2.083 0.042 Postoperative hospitalization duration 6.76 ± 2.82 5.59 ± 1.57 1.954 0.057 Postoperative bed rest time 4.96 ± 2.29 1.47 ± 0.98 7.560 0 Barthel index 74.66 ± 16.53 80.34 ± 10.77 -1.553 0.127 6-MWT 135.65 ± 35.39 165.71 ± 44.74 -2.256 0.030 Table 5 Exercise adherence and exercise capacity of patients 1 months after discharge Control Group number (%)/mean ± S Intervention Group number (%)/mean ± S t/χ 2 P Regular exercise 12(41.4) 22(75.9) 7.108 0.008 6-MWT 282.82 ± 94.52 342.21 ± 97.63 -2.332 0.023 Table 6 Exercise adherence of patients 3 months after discharge Regular exercise number (%) Iregular exercise number (%) χ 2 P Intervention group 21(72.4) 8(27.6) Control group 13(44.8) 16(55.2) 4.549 0.033 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6539160","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":459269758,"identity":"6b0a9222-d15e-4e21-8850-9ed809db6c05","order_by":0,"name":"Yanxin Song","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanxin","middleName":"","lastName":"Song","suffix":""},{"id":459269759,"identity":"7b782bd6-afd4-4beb-b1ab-38ab55dfe47c","order_by":1,"name":"Haiyan Zheng","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haiyan","middleName":"","lastName":"Zheng","suffix":""},{"id":459269760,"identity":"c5c08157-0d50-4c22-b930-fc9f7c0c7f2f","order_by":2,"name":"Chuan Ren","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chuan","middleName":"","lastName":"Ren","suffix":""},{"id":459269761,"identity":"a3937c61-6b7f-4c71-801e-59634f881fa3","order_by":3,"name":"Wei Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBACAxiDn5n54ANitTA2gBiS7WzJBgQUo2kxOM9jJkCUFnP25ucPPjAcTtx8mMGMgaHGJpqgFsueY4aNM4Bath1mSHvAcCwtt4Ggw24kGDbzMKQZmx1mOG7A2HCYCC33n39s/gPUYtzM2CZBnJYbPIbNDAw2cgbMzGzEabHsySmc2QPUInGYjdkggRi/mLMf3/DhB4MED3//+Y8PPtTYENYCBoz/oIwEopSPglEwCkbBKCAIAMkFO67PfzBXAAAAAElFTkSuQmCC","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhao","suffix":""},{"id":459269762,"identity":"ce4814d2-24ea-44ac-a062-a956b5ae609d","order_by":4,"name":"Jinan Wang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinan","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-04-27 08:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6539160/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6539160/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83436247,"identity":"4bd3ea45-e5b9-4671-8bb5-829ac0a4262b","added_by":"auto","created_at":"2025-05-26 08:33:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":356615,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of the study.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6539160/v1/e4d2c2927986e8a1de713fc6.jpeg"},{"id":98421189,"identity":"5518a818-e47a-4dbe-a17d-1e7cf49756e8","added_by":"auto","created_at":"2025-12-17 16:24:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1081944,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6539160/v1/639d4d10-dfac-4c44-b44d-03de65df5db7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing TAVR","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHeart valve disease is a common type of cardiovascular disease. Transcatheter aortic valve replacement (TAVR) is a new method for treating patients with aortic stenosis (AS) or aortic regurgitation (AR) in recent years\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. At present, the majority of patients receiving TAVR are elderly, with multiple comorbidities and poor physical condition. These patients have a higher likelihood of developing complications, such as pulmonary infection and deep vein thrombosis in the lower limbs during hospitalization. Preoperative and postoperative rehabilitation treatment for these patients can reduce the occurrence of these complications\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Consensus among experts in Europe, America, and China recommends early initiation of rehabilitation before and after TAVR surgery\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. At present, the cardiac rehabilitation of TAVR patients in China is still in its early stage, mostly initiated after surgery\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, and more emphasis is placed on exercise rehabilitation. Respiratory rehabilitation is not completely included in the entire rehabilitation process\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, and there is a lack of unified exercise programs, and no systematic evaluation methods to evaluate the effects of rehabilitation. This article introduces the program and effects of perioperative cardiopulmonary integrated rehabilitation for TAVR patients at Peking University Third Hospital, providing evidence for the improvement of the cardiac rehabilitation model for Chinese TAVR patients.\u003c/p\u003e"},{"header":"Data and Methods","content":"\u003cp\u003eInformation\u003c/p\u003e \u003cp\u003eFrom January to August 2022, 29 patients who received TAVR were retrospectively enrolled as the control group, and from September 2022 to May 2024, 29 patients who were scheduled to recieve TAVR were prospectively enrolled as the intervention group. This study has been approved by the Medical Ethics Committee of Peking University Third Hospital (Approval No.: M2021321). Both the patient and their family members provided informed consent.\u003c/p\u003e \u003cp\u003eInclusion criteria\u003c/p\u003e \u003cp\u003eInclusion criteria were the following: diagnosed with degenerative aortic disease before surgery, no mental illness or functional impairment, without serious complications after surgery, consciousness, informed consentation.\u003c/p\u003e \u003cp\u003eExclusion criteria\u003c/p\u003e \u003cp\u003eExclusion criteria were as follows: undergoing emergency valve replacement surgery; undergoing cardiac re-surgery; severe functional impairment of important organs such as lungs, liver, and kidneys before surgery; unable to take care of oneself; unable to take part in cardiac rehabilitation; died within 72 hours after surgery.\u003c/p\u003e \u003cp\u003eMethod\u003c/p\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eThe control group patients received routine treatment and nursing care during hospitalization. Besides routine treatment and nursing, the interventional group recieved a perioperative cardiopulmonary integrated rehabilitation program after admission\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The program included ⑴ preoperative evaluation: collecting patients\u0026rsquo; detailed medical history; evaluating the patients\u0026rsquo; preoperative valve function of the structural heart disease, EuroSCORE score, New York Heart Association heart function classification, functional evaluation of important organs such as heart, lung, brain, and kidney; examining factors related to exercise such as motor system and nervous system factors (muscle strength, joint mobility, coordination function, balance capacity, etc.); evaluating patients\u0026rsquo; daily exercise habits and exercise volume, frailty, nutritional status, cognitive function, psychological state, quality of life, and activities of daily living. ⑵ Preoperative rehabilitation education and comprehensive rehabilitation program including medication, exercise, nutrition, psychology, sleep, and smoking cessation before and after surgery. ⑶ Preoperative cardiopulmonary rehabilitation: contracted lips breath and abdominal breath were used to improve respiratory function, guiding patients to effectively cough; the large muscle groups of the upper and lower limbs exercising to enhance muscle strength, and maintain consistent breathing and limbs movement during the exercise process; walking training and taking stationary steps to enhance cardioulmonary endurance, while maintaining a steady breathing rate during exercise. According to the patient's tolerance, the rehabilitation duration continued 20\u0026ndash;30 minutes, 1\u0026ndash;2 times a day. ⑷ Early postoperative rehabilitation assessment: after TAVR surgery, patients could enter the intensive care unit, when their vital signs kept stable, they could undergo early postoperative rehabilitation assessment, including puncture site, catheterization, mental state, communicational ability, muscle strength assessment, pain assessment, and limbs mobility. ⑸ Postoperative cardiopulmonary rehabilitation: During bed rest stage, changing patients\u0026rsquo; posture, helping patients\u0026rsquo; turn over, limb activities locally(passive and auxiliary moving when patients were not awake; therapist assisted or patient actively exercising when patients were awake, keeping breathing and movement consistent), respiratory rehabilitation, coughing and sputum discharge training; limb training, standing balance, walking, and coordinated training. According to the patient's tolerance, the rehabilitation duration continued 30\u0026ndash;40 minutes each time, twice a day. During the rehabilitation process, closely monitor the patient's vital signs. If the patient experienced ① new onset of arrhythmia, ② ST segment changes on electrocardiogram, ③ dyspnea, ④ obvious fatigue intolerance, the rehabilitation program must be stopped, and give the patient medical treatment. Researchers recorded the patients\u0026rsquo; activities of daily living (Barthel Index) at admission and discharge. Before the patients discharge, researchers instructed patients to perform a 6-minute walking test(6-MWT) to assess patients\u0026rsquo; exercise capacity, and provided rehabilitation guidance based on their 6-MWT results. Researchers regularly monitored the exercise of interventional group patients through WeChat. At the 1-month follow-up, researchers evaluated all patients\u0026rsquo; exercise adherence and retest their 6-MWT. Researchers conducted a telephone survey on the patient's exercise adherence 3 months after discharge.\u003c/p\u003e \u003cp\u003eEvaluation indicators\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; incidence of postoperative respiratory distress (Borg respiratory distress score), fever, infection, etc.; postoperative physical activity status of patients; patients\u0026rsquo; exercise capacity and exercise adherence 1 month after discharge; patient's exercise adherence 3 months after discharge.\u003c/p\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003cp\u003eUsing SPSS 25.0 statistical software for analysis, normality test and homogeneity of variance test were performed first. Normally distributed measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s) and independent sample t-test was used. Non-normally distributed measurement data were expressed as median and interquartile range [M (Q25, Q75)] and non-parametric test were used. The enumeration data were expressed as percentages and chi square test was used. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline data\u003c/p\u003e \u003cp\u003eThere were no statistically significant differences in height, weight, BMI, age, gender, comorbidities, preoperative cardiac function, type of valve disease, valve surgery risk, medication use, and activities of daily living(ADL, Barthel index) between the two groups of patients(P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e3.2 Rehabilitation Effects\u003c/p\u003e \u003cp\u003eComparison of occurrence of postoperative dyspnea, fever and infection between the two groups is shown in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The incidence of dyspnea and fever in the intervention group was significantly lower than that in the control group(P\u0026thinsp;=\u0026thinsp;0.028 and P\u0026thinsp;=\u0026thinsp;0.033, respectively). No interventional patient showed sever dyspnea. No adverse events occurred during the rehabilitation process of all patients.\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; duration of hospitalization and physical activity of the two groups is shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The intervention group exhibited significantly shorter postoperative bed rest duration and CCU hospitalization duration compared to the control group, with a statistically significant difference(P\u0026thinsp;=\u0026thinsp;0 and P\u0026thinsp;=\u0026thinsp;0.042, respectively). Furthermore, while the intervention group showed better performance in postoperative hospital stay length and daily living activities than the control group, no statistically significant difference was observed. Additionally, the 6-MWT at discharge was significantly longer in the intervention group versus the control group(135.65\u0026thinsp;\u0026plusmn;\u0026thinsp;35.39 vs. 165.71\u0026thinsp;\u0026plusmn;\u0026thinsp;44.74, P\u0026thinsp;=\u0026thinsp;0.030).\u003c/p\u003e \u003cp\u003eWhen the patient came to the hospital for a follow-up 1 month after discharge, the patient's 6-MWT was retested and their exercise habits were investigated. Patients in the intervention group demonstrated significantly better exercise adherence and 6-MWT compared to the control group. See Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAfter 3 months of discharge, telephone follow-up was conducted on the patient's exercise adherence. The superiority in exercise adherence persisted in the intervention group at 3 months post-discharge when compared with controls(P\u0026thinsp;=\u0026thinsp;0.033). See Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSince 2002, TAVR has undergone more than 20 years of development, and its safety and efficacy have been confirmed by multiple large-scale, multicenteral, prospective, randomized controlled trials, as well as clinical registration studies, gradually expanding its indications to low-risk patients\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. However, the current rehabilitation work for TAVR patients is still incomplete, with studies showing that less than 1 in 3 patients take part in cardiac rehabilitation, which is mostly the outpatient rehabilitation\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. This study is based on the experience and guidelines of TAVR rehabilitation in China and abroad\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. According to the physiological characteristics of the heart and lungs\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, we carried out perioperative cardiopulmonary integrated rehabilitation for TAVR patients in our hospital, and appoved its efficiency.\u003c/p\u003e \u003cp\u003eThe mian findings are as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerioperative cardiopulmonary integrated rehabilitation can shorten TAVR patients\u0026rsquo; postoperative bed rest time, length of CCU residence; improve patients\u0026rsquo; physical activity status.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerioperative cardiopulmonary integrated rehabilitation can reduce TAVR patients\u0026rsquo; incidence of postoperative complications (such as dyspnea and fever).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerioperative rehabilitation and regular follow-up can improve TAVR patients\u0026rsquo; exercise adherence and prolong the rehabilitation effects after discharge.\u003c/p\u003e \u003cp\u003ePerioperative cardiopulmonary integrated rehabilitation improve TAVR patients\u0026rsquo; physical activity status\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003ePerioperative rehabilitation has been well-established in surgical patients and currently, there is evidence of TAVR perioperative rehabilitation\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. However, there are still a large number of TAVR patients just take part in rehabilitation program after surgery\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, often ignore prerehabilitation\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. In this study, the staff conducted prerehabilitation evaluation and intervention for TAVR patients, and provided them with a certain understanding of the surgery through preoperative education. Cardiopulmonary rehabilitation training before surgery can improve patients' cardiopulmonary function and ADL\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, allowing them to prepare for surgery from both psychological and physiological aspects. In addition, Steinmetz\u0026rsquo;s study has shown that preoperative rehabilitation can improve patients' 6-minute walking distance after surgery\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. After patients return to the cardiac intensive care unit after surgery and their vital signs are stable, the postoperative rehabilitation begins as soon as possible. As early as 2010, the updated guidelines of the American Heart and Lung Association/American Heart Association clearly stated that early exercise rehabilitation can help patients regain mobility and self-care ability quickly\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, and be discharged quickly\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Obafemi\u0026rsquo;s study has shown that cardiopulmonary integrated rehabilitation could reduce patients\u0026rsquo; mean length of ICUand hospital stay by 1\u0026ndash;3 days and 1\u0026ndash;7 days, respectively\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. We got the similar results in our study. The average postoperative bed rest time of interventional patients in our study was 1.47 days, which was significantly shorter than the control group and other study\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. What\u0026rsquo;s more, the interventional patients\u0026rsquo; exercise capacity was better than the control patients(6-MWT: 165.71\u0026thinsp;\u0026plusmn;\u0026thinsp;44.74 vs. 135.65\u0026thinsp;\u0026plusmn;\u0026thinsp;35.39, P\u0026thinsp;=\u0026thinsp;0.030).\u003c/p\u003e \u003cp\u003ePerioperative cardiopulmonary integrated rehabilitation reduce TAVR patients\u0026rsquo; incidence of postoperative complications\u003c/p\u003e \u003cp\u003ePrevious study has shown that cardiopulmonary integrated rehabilitation could reduce bronchopneumonia rate from 18.8 to 9.7% in patients undergoing CABG\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Moreover, Hui\u0026rsquo;s study showed that cardiopulmonary integrated rehabilitation could also be applied to patients with heart failure, and individualized rehabilitation training significantly improved patients\u0026rsquo;6-MWT and the SF-36 score\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Patients who receive TAVR are mostly elderly, weak, and have multiple chronic diseases. In this study, 34.5% of the intervention group had chronic lung disease, and nearly 1/4 of the patients had heart failure. Cardiopulmonary integrated rehabilitation not only improves patients' cardiopulmonary endurance, but also enhanced the endurance of respiratory muscles, established effective breathing patterns, alleviated dyspnea, ensured effective ventilation and cough, and reduced the occurrence of postoperative pulmonary complications\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In this study, the incidence of fever, dyspnea, and degree of dyspnea of the intervention group were lower than that of the control group.\u003c/p\u003e \u003cp\u003eKleczynski's study\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e found that although participation in rehabilitation during hospitalization can improve patients' clinical status and quality of life, the probability of patients participating in cardiac rehabilitation decreases after discharge, it was the same in our study. Desai believe that patients who have participated in cardiac rehabilitation programs are more likely to adhere to cardiac rehabilitation\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, while Oz's systematic review suggests the need to encourage TAVR patients to regularly participate in cardiac rehabilitation after discharge\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The rehabilitation program of this study made patients aware of the significance of cardiopulmonary rehabilitation during hospital, and conducted regular telephone follow-up after patients discharge to promote them to take part in regular cardiac rehabilitation outside the hospital. 75.6% and 72.4% of patients in the interventional group exercised regularly after 1 month and 3 months discharge respectively, which were significantly higher than that in the control group (P\u0026thinsp;=\u0026thinsp;0.008 and P\u0026thinsp;=\u0026thinsp;0.033, respectively).\u003c/p\u003e \u003cp\u003ePerioperative rehabilitation and regular follow-up improve TAVR patients\u0026rsquo; exercise adherence and prolong the rehabilitation effects\u003c/p\u003e \u003cp\u003eIt is important to note that This study is the first investigation to apply cardiopulmonary integration rehabilitation among Chinese perioperative patients undergoing TAVR, and demonstrated its efficacy in reducing postoperative complications and enhancing postoperative mobility. However, the study has limitations, including a limited sample size and a non-randomized controlled trial design. Therefore, larger-scale randomized controlled trials may well be considered to further explore more effective rehabilitation methods.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePerioperative cardiopulmonary integrated rehabilitation for TAVR patients can reduce the occurrence of complications, promote early mobilization and discharge, improve exercise capacity, and restore daily life. Early rehabilitation in hospital and regular follow-up can help patients adhere to rehabilitation program after discharge, prolong rehabilitation benefits, improve quality of life, and have high health and socio-economic value.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe authors confirm that the data supporting the findings of this study are available within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions:\u0026nbsp;\u003c/strong\u003eSYX: Study design, data analysis, and writing the original draft. ZHY, WJN: Paper screening and data extraction. RC, ZW: Quality assessment, and writing-review. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement:\u0026nbsp;\u003c/strong\u003eAll procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eYouth Incubation Fund of Peking University Third Hospital (BYSYFY2021013),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eClinical Key Project of Peking University Third Hospital (BYSYFZD2021008),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eResearch Project of Beijing Chronic Disease Prevention and Health Education Research Association (BJMB0012021025025).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStructural Cardiology Professional Committee of the Cardiovascular Physicians Branch of the Chinese Medical Association. 2021 Expert consensus on clinical pathway for transcatheter aortic valve replacement in China[J]. 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align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003enumber (%)/mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group number (%)/mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et/χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperuricemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic lung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute myocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165.21\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66.21\u0026thinsp;\u0026plusmn;\u0026thinsp;10.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.93\u0026thinsp;\u0026plusmn;\u0026thinsp;14.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.86\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.55\u0026thinsp;\u0026plusmn;\u0026thinsp;12.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePASP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38.95\u0026thinsp;\u0026plusmn;\u0026thinsp;17.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.64\u0026thinsp;\u0026plusmn;\u0026thinsp;14.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.52\u0026thinsp;\u0026plusmn;\u0026thinsp;15.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHgb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130.07\u0026thinsp;\u0026plusmn;\u0026thinsp;18.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood glucose (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.70\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScr (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95.31\u0026thinsp;\u0026plusmn;\u0026thinsp;45.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105.48\u0026thinsp;\u0026plusmn;\u0026thinsp;78.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEuroSCORE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNT-proBNP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e526(188.50,1955.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1451(213.00,4420.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eΒeta-blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACEI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiuretics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72.24\u0026thinsp;\u0026plusmn;\u0026thinsp;26.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.66\u0026thinsp;\u0026plusmn;\u0026thinsp;23.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAS, Aortic stenosis; BMI, Body mass index; LVEDD, Left ventricular end-diastolic dimension; LVESD, Left ventricular end-systolic dimension; LAP, Left atrial pressure; PASP, Pulmonary arterial systolic pressure; LVEF, Left ventricular ejection fractio; Hgb, Hemoglobin; EuroSCORE, European System for Cardiac Operative Risk Evaluation; NT-proBNP, N-terminal pro brain natriuretic peptide; ACEI, Angiotensin converting enzyme inhibitors; ARB, Angiotensin II receptor blockage.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of incidence of postoperative dyspnea, fever, and infection between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group number (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group number (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDegree of dyspnea between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group number (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(89.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of postoperative hospitalization and physical activity of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group\u003c/p\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative length of CCU residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospitalization duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative bed rest time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e74.66\u0026thinsp;\u0026plusmn;\u0026thinsp;16.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e80.34\u0026thinsp;\u0026plusmn;\u0026thinsp;10.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-MWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e135.65\u0026thinsp;\u0026plusmn;\u0026thinsp;35.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e165.71\u0026thinsp;\u0026plusmn;\u0026thinsp;44.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExercise adherence and exercise capacity of patients 1 months after discharge\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003enumber (%)/mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group number (%)/mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et/χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-MWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e282.82\u0026thinsp;\u0026plusmn;\u0026thinsp;94.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e342.21\u0026thinsp;\u0026plusmn;\u0026thinsp;97.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExercise adherence of patients 3 months after discharge\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular exercise\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIregular exercise\u003c/p\u003e \u003cp\u003enumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13(44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cardiac rehabilitation, Cardiopulmonary integrated rehabilitation, Aortic stenosis, Aortic regurgitation, Transcatheter aortic valve replacement","lastPublishedDoi":"10.21203/rs.3.rs-6539160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6539160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo explore the effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing transcatheter aortic valve replacement (TAVR) .\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eFollowing the initiation of the trial, 29 patients who received TAVR were prospectively enrolled as the intervention group, and 29 patients who received TAVR were retrospectively enrolled as the control group. The control group patients received routine treatment and nursing care after admission. Besides routine treatment and nursing care, a perioperative cardiopulmonary integrated rehabilitation program was carried out for the interventional group after admission. Patients\u0026rsquo; incidence of postoperative dyspnea, fever, infection, etc.; postoperative physical activity status and duration of hospitalization; exercise capacity and exercise adherence 1 month after discharge; exercise adherence 3 months after discharge were compared between the two groups.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eNo adverse events occurred in all patients. Compared with the control group, the intervention group had lower incidence of dyspnea and fever (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), significantly shorter postoperative length of CCU residence and bed rest time (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), better physical activity status and exercise capacity, and higher exercise adherence after discharge (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe perioperative cardiopulmonary integrated rehabilitation in TAVR patients is safe and effective.\u003c/p\u003e","manuscriptTitle":"The effects of perioperative cardiopulmonary integrated rehabilitation in patients undergoing TAVR","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 08:33:49","doi":"10.21203/rs.3.rs-6539160/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8bbd0fe-935c-4d7b-b981-66e6103c7d04","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-10T18:23:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 08:33:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6539160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6539160","identity":"rs-6539160","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}