Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI)
Andreas W. Schoenenberger,Stefan Stortecky,Stephanie Neumann,André Moser,Peter Jüni,Thierry Carrel,Christoph Huber,Marianne Gandon,Seraina Bischoff,Christa-Maria Schoenenberger,Andreas E. Stuck,Stephan Windecker,Peter Wenaweser +12 more
TLDR
Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI, and the frailty index, but not established risk scores, was predictive of functional decline.Abstract:
Aims This study aimed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation (TAVI) and to find predictors of functional decline. Methods and results In this prospective cohort, functional course was assessed in patients ≥70 years using basic activities of daily living (BADL) before and 6 months after TAVI. Baseline EuroSCORE, STS score, and a frailty index (based on assessment of cognition, mobility, nutrition, instrumental and basic activities of daily living) were evaluated to predict functional decline (deterioration in BADL) using logistic regression models. Functional decline was observed in 22 (20.8%) of 106 surviving patients. EuroSCORE (OR per 10% increase 1.18, 95% CI: 0.83-1.68, P = 0.35) and STS score (OR per 5% increase 1.64, 95% CI: 0.87-3.09, P = 0.13) weakly predicted functional decline. In contrast, the frailty index strongly predicted functional decline in univariable (OR per 1 point increase 1.57, 95% CI: 1.20-2.05, P = 0.001) and bivariable analyses (OR: 1.56, 95% CI: 1.20-2.04, P = 0.001 controlled for EuroSCORE; OR: 1.53, 95% CI: 1.17-2.02, P = 0.002 controlled for STS score). Overall predictive performance was best for the frailty index [Nagelkerke's R(2) (NR(2)) 0.135] and low for the EuroSCORE (NR(2) 0.015) and STS score (NR(2) 0.034). In univariable analyses, all components of the frailty index contributed to the prediction of functional decline. Conclusion Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI. The frailty index, but not established risk scores, was predictive of functional decline. Refinement of this index might help to identify patients who potentially benefit from additional geriatric interventions after TAVI.read more
Citations
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The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments
Carlos Rodríguez-Pascual,Carlos Rodríguez-Pascual,Emilio Paredes-Galán,A.I. Ferrero-Martinez,José Antonio Baz-Alonso,Darío Durán-Muñoz,Eva Gonzalez-Babarro,Marcelo Sanmartín,Teresa Parajes,Ivett Torres-Torres,Miguel Piñón-Esteban,Francisco Calvo-Iglesias,Maria Teresa Olcoz-Chiva,Fernando Rodríguez-Artalejo +13 more
TL;DR: Frailty is associated with increased mortality among patients with symptomatic SAS, and this association does not vary with the type of SAS treatment, but future studies evaluating the benefits of different treatments in SAS patients should account for baseline frailty.
Journal ArticleDOI
TAVI and the future of aortic valve replacement.
TL;DR: Within intermediate‐risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30‐d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission.
Journal ArticleDOI
Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease
Egle Tamuleviciute-Prasciene,Kristina Drulyte,Greta Jurenaite,Raimondas Kubilius,Birna Bjarnason-Wehrens +4 more
TL;DR: Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.
Journal ArticleDOI
Transfemoral TAVR in Nonagenarians: From the CENTER Collaboration
Wieneke Vlastra,Jaya Chandrasekhar,Jeroen Vendrik,Enrique Gutiérrez-Ibañes,Didier Tchetche,Fabio Sandoli de Brito,Marco Barbanti,Ran Kornowski,Azeem Latib,Augusto D'Onofrio,Flavio Ribichini,Jan Baan,Jan G.P. Tijssen,Manuel Pan,Nicolas Dumonteil,José Armando Mangione,Samantha Sartori,Paola D'Errigo,Giuseppe Tarantini,Mattia Lunardi,Katia Orvin,Matteo Pagnesi,Joaquin Sanchez Gila,Thomas Modine,George Dangas,Roxana Mehran,Jan J. Piek,Ronak Delewi +27 more
TL;DR: Mortality after transfemoral TAVR was 2-fold higher in nonagenarians compared with patients younger than 90 years of age, despite the lower prevalence of baseline comorbidities, and nonagenarians had a higher risk of in-hospital stroke, major or life-threatening bleeding, and new-onset atrial fibrillation.
Journal ArticleDOI
Frailty Phenotype and Deficit Accumulation Frailty Index in Predicting Recovery After Transcatheter and Surgical Aortic Valve Replacement.
Sandra M. Shi,Jonathan Afilalo,Lewis A. Lipsitz,Lewis A. Lipsitz,Jeffrey J. Popma,Kamal R. Khabbaz,Roger J. Laham,Kim Guibone,Francine Grodstein,Eliah Lux,Dae Hyun Kim,Dae Hyun Kim +11 more
TL;DR: Deficit-accumulation FI provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing SAVR and TAVR, and improves prediction to a traditional surgical risk model.
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