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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Editor’s Choice - Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association:
David Walker,Chris P Gale,Gregory Y.H. Lip,Gregory Y.H. Lip,Francisco Javier Martín-Sánchez,H F McIntyre,Christian Mueller,Susanna Price,Juan Sanchis,María T. Vidán,C Wilkinson,U Zeymer,Héctor Bueno +12 more
TL;DR: The latest evidence about frailty and the management of frail patients with acute cardiovascular disease is presented, and avenues for future research are suggested.
Journal ArticleDOI
Evolution of Transcatheter Aortic Valve Replacement
TL;DR: The evolution of transcatheter aortic valve replacement is reviewed, the first steps in this field are presented, the evidence from registries and clinical trials are cited, the limitations of this treatment are highlighted, and the future perspectives and the developments proposed to address the current pitfalls are discussed.
Journal ArticleDOI
Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.
Gianni Dall'Ara,Hélène Eltchaninoff,Neil Moat,Cécile Laroche,Javier Goicolea,Gian Paolo Ussia,Petr Kala,Peter Wenaweser,Marian Zembala,Georg Nickenig,Thomas Snow,Susanna Price,Eduardo Alegria Barrero,Rodrigo Estévez-Loureiro,Bernard Iung,José Luis Zamorano,Gerhard Schuler,Ottavio Alfieri,Bernard D. Prendergast,Peter Ludman,Stephan Windecker,Manel Sabaté,Martine Gilard,Adam Witkowski,Haim D. Danenberg,Erwin Schroeder,Francesco Romeo,Carlos Macaya,Geneviève Derumeaux,Alessio Mattesini,Luigi Tavazzi,Carlo Di Mario +31 more
TL;DR: In this paper, the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local anaesthetic (LA-group, 1095 patients, 39%) or general anaesthesia (GA)-group, 1712 patients, 61%).
Journal ArticleDOI
Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement: A Systematic Review
Caroline A. Kim,Suraj P. Rasania,Jonathan Afilalo,Jeffrey J. Popma,Lewis A. Lipsitz,Dae Hyun Kim +5 more
TL;DR: Transcatheter aortic valve replacement (TAVR) prolongs survival in high-risk patients with severe stenosis, but its functional and quality-of-life benefits have not been established.
Journal ArticleDOI
Psoas Muscle Area and All-Cause Mortality After Transcatheter Aortic Valve Replacement: The Montreal-Munich Study
Samuel Mamane,Louis Mullie,Nicolo Piazza,Giuseppe Martucci,José A. Morais,Antonio Vigano,Mark Levental,Kristoff Nelson,Ruediger Lange,Jonathan Afilalo +9 more
TL;DR: In this article, the cross-sectional area of the left and right psoas muscles on a single axial slice at the level of L4 was measured from computed tomography images to predict risk in older adults referred for transcatheter aortic valve replacement (TAVR).
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