Exercise-based cardiac rehabilitation after transcatheter aortic valve replacement: a systematic review and meta-analysis of randomized controlled trials

Background Many patients remain functionally limited after transcatheter aortic valve replacement (TAVR) despite successful correction of aortic stenosis. Exercise-based cardiac rehabilitation (EBCR) is effective in other cardiac populations, but its benefits after TAVR remain uncertain. This study evaluated the impact of EBCR on functional capacity, cardiac function, quality of life, and safety outcomes in post-TAVR patients.Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) published through February 2025 was conducted using major databases. Outcomes were pooled using mean differences or risk ratios with 95% confidence intervals.Results Six RCTs with 272 patients were included. No significant difference was found between EBCR and usual care for peak VO2 change (MD: 1.46, 95% CI: [−0.16 to 3.08], p = 0.076) and six-minute walk distance (6MWD) change (MD: 18.72, 95% CI: [−2.24 to 39.68], p = 0.08). Similarly, no significant difference was observed between EBCR and usual care for left ventricular ejection fraction (LVEF) change (MD: 1.31, 95% CI: [−2.06 to 4.69], p = 0.45), and aortic valve orifice area change (AVOA) (MD: −0.03, 95% CI: [−0.24 to 0.18], p = 0.78).Conclusion EBCR did not significantly improve outcomes after TAVR; however, near-significant trends in functional capacity warrant further large-scale investigation.Protocol Registration PROSPERO ID CRD420250652719.