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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Journal ArticleDOI
Evolution of Basic Activities of Daily Living Function in Older Patients One Year After Transcatheter Aortic Valve Implantation
Dominic Bertschi,André Moser,Stefan Stortecky,Marcel Zwahlen,Stephan Windecker,Thierry Carrel,Andreas E. Stuck,Andreas W. Schoenenberger +7 more
TL;DR: To assess the course and prediction of basic activities of daily living (ADL) function in patients after transcatheter aortic valve implantation (TAVI), results show clear trends in survival and morbidity after TAVI.
Journal ArticleDOI
2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
Joseph E. Bavaria,Carl L. Tommaso,Ralph G. Brindis,John D. Carroll,G. Michael Deeb,Ted Feldman,Thomas G. Gleason,Eric Horlick,Clifford J. Kavinsky,Dharam J. Kumbhani,D. Craig Miller,A. Allen Seals,David M. Shahian,Richard J. Shemin,Thoralf M. Sundt,Vinod H. Thourani +15 more
TL;DR: The multisocietal Expert Consensus Systems of Care (ECSOC) document was published by the American Association for Thoracic Surgery (AATS), the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions (SCAI), and the Society of Thoracian Surgeons (STS) as mentioned in this paper.
Journal ArticleDOI
Documento di consenso ANMCO/SIC/SICI-GISE/SICCH: Stratificazione del rischio in chirurgia cardiaca e per l’impianto transcatetere di valvola aortica specifico per il paziente anziano
Giovanni Pulignano,Michele Massimo Gulizia,Samuele Baldasseroni,Francesco Bedogni,Giovanni Cioffi,Ciro Indolfi,Francesco Romeo,Adriano Murrone,Francesco Musumeci,Alessandro Parolari,Leonardo Patanè,Paolo Giuseppe Pino,Annalisa Mongiardo,Carmen Spaccarotella,Roberto Di Bartolomeo,Giuseppe Musumeci +15 more
TL;DR: A number of factors including multimorbidity, disability, frailty and cognitive function should be considered in order to assess the expected benefit of TAVI.
Journal ArticleDOI
Évaluation gériatrique avant décision de remplacement valvulaire aortique par voie percutanée chez des patients âgés fragiles et suivi à un an : intérêt d’une collaboration cardio-gériatrique ?
TL;DR: La prise en charge optimale des patients âges fragiles necessitant un TAVI doit etre mulitdisciplinaire, impliquant les cardiologues, les anesthesistes et les geriatres.
Journal ArticleDOI
Transatlantic Editorial on transcatheter aortic valve replacement.
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