The effect of I COUGH-WCH Perioperative care bundle in patients undergoing transapical transcatheter aortic valve replacement: a randomized controlled trial
Z Luo, Y Q Wang, X Zhang, W Huang, X Liu, M Chen, P M YuAbstract
Background
Appropriate strategies to improve the medical care quality in transapical transcatheter aortic valve replacement (TA-TAVR) are urgently warranted. Recent evidence suggests that pre-operative physiotherapy is associated with better outcomes in patients undergoing elective cardiac surgery. To investigate the feasibility and effectiveness of the modified I COUGH care bundle (I COUGH-WCH).
Methods and Results
A single-blinded controlled trial was conducted from 2023 to 2025. Participants who eligible for TA-TAVR were recruited and randomly assigned to either I COUGH-WCH care bundle group (IG) or standard ERAS group (CG) in a 1:1 ratio. Of 144 participants, 52.08% were male, the mean age was 70.79 years. The postoperative respiratory complications were present in 16 of 72 participants in the IG (22.22%) and 30 of 72 in the CG (41.67%) (RR: 0.533, 95% CI: 0.320-0.889, P=0.012). The respiratory function and exercise capacity of the IG were consistently better than those of the CG before discharge, 1-month after discharge, and 3-month after discharge (P<0.05).
Conclusion
Implementation of I COUGH-WCH care bundle effectively reduces the incidence of PPCs, enhances postoperative functional capacity, and improves quality of life in patients undergoing TA-TAVR. These findings support its adoption as a standardized perioperative management protocol in this patient population.Graphical abstract