Objective To systematically assess postoperative changes in physical activity (PA) and their influence on clinical outcomes among elderly patients after transcatheter aortic valve replacement (TAVR), providing an evidence-based framework for risk stratification and the design of personalized cardiac rehabilitation programs. Methods A systematic search was conducted in CNKI, Wanfang, SinoMed, PubMed, Web of Science, and the Cochrane Library for relevant literature published from April 16, 2002 to January 1, 2026. Eligible studies included patients with a mean age of ≥65 years who underwent TAVR, with assessments of PA both pre- and postoperatively, and reported clinical outcomes stratified by the trajectory of PA change. Two reviewers independently performed study selection, data extraction, and quality appraisal using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Cochrane Risk-of-Bias tool for randomized controlled trials. ResultsFour studies, all assessed as high-quality (three cohort studies with an NOS score of 8 and one randomized controlled trial with "some concerns" for risk of bias) encompassing 1 278 patients were included. The mean age was (82.2±7.3) years, and 52.0% were female. The results demonstrated a strong association between postoperative PA trajectories and clinical outcomes. Patients with persistently low or declining PA exhibited significantly higher risks of all-cause mortality, composite cardiovascular events, and rehospitalization compared to those whose PA improved or remained stable. A notable "protective effect of functional improvement" was observed: patients with low baseline PA who achieved significant postoperative improvement had prognosis comparable to those with normal baseline PA. Multivariable analyses identified advanced age, female sex, comorbidities such as chronic obstructive pulmonary disease, and cognitive impairment as independent predictors of impaired postoperative PA recovery. Conclusion Dynamic postoperative PA trajectories are a key predictor of clinical outcomes in the elderly TAVR population. This allows for risk stratification to identify a "low-benefit" high-risk cohort, for whom targeted, individualized cardiac rehabilitation interventions are crucial to optimize long-term survival and enhance quality of life.
Objective To propose a whole-life cycle management model for valvular heart disease (VHD), systematically elucidate its underlying logic and implementation pathways, and concurrently review and analyze its preliminary application outcomes. Methods Since 2020, West China Hospital of Sichuan University has established a management system encompassing "assessment-decision-intervention-follow-up", including: (1) a risk-stratified, tiered management pathway; (2) six core functions ("promotion, screening, prevention, diagnosis, treatment, and rehabilitation") coordinated by disease-specific managers; (3) an intelligent decision support information platform; and (4) a collaborative network of multidisciplinary teams and regional academic alliances. To evaluate the effectiveness of this management model, we retrospectively included three cohorts: (1) the population screened by echocardiography from 2020 to 2024, analyzing the detection rate of aortic valve disease and risk stratification; (2) patients enrolled in the whole-life cycle management from April 2021 to December 2024, assessing follow-up outcomes, hospital satisfaction, and changes in quality of life; (3) patients who underwent transcatheter aortic valve replacement (TAVR) from January 2022 to January 2024, evaluating the one-year all-cause mortality rate, perioperative complications, and improvements in New York Heart Association (NYHA) classification. Results Between 2020 and 2024, a total of 583 874 individuals underwent echocardiographic screening. A total of 48 089 patients with aortic valve disease were identified, including 3 401 (7.1%) high-risk patients, 18 657 (38.8%) moderate-risk patients, and 26 031 (54.1%) low-risk patients. Among them, 2 417 patients were enrolled in whole-life cycle management. Patient satisfaction scores showed a yearly increase, rising from 73.89 points before 2020 to 93.74 points in 2024. The 1-year mortality rate in the TAVR cohort decreased to 5.3%, significantly lower than the 8.2% observed under early standard management between 2014 and 2019 (P<0.01). Conclusion Through process optimization and resource integration, the VHD whole-life cycle management model has demonstrated significant effectiveness in standardizing diagnostic and follow-up procedures, enhancing patient satisfaction and quality of life, and reducing mortality. These outcomes highlight its practical value for broader implementation in China.