Objective The term frailty is frequently used during decision-making in transcatheter heart valve procedures. Nevertheless, frailty is still measured by eyeballing rather than by using standardized frailty assessments. In a previous study, we developed a frailty score in a cardiac surgical patient population including patients, who underwent transcatheter aortic valve replacement (TAVR). Here, we present the results from the subsequent validation study focusing on the TAVR cohort. Methods One hundred thirty patients underwent TAVR. Frailty assessment using the FORECAST (Frailty predicts death One yeaR after Elective CArdiac Surgery Test) was performed. The European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons (STS) score were assessed as well. Follow-up included assessment of in-hospital and 30-day mortality and morbidity and quality of life using the Short Form-36 questionnaire. Results Mean age was 83.3 years, and 50% were female. Logistic European System for Cardiac Operative Risk Evaluation was 14.9 ± 8.7%, and STS score was 5.1 ± 3.4%. Mean ± standard deviation FORECAST score was 4.8 ± 3.3 points of 15. In-hospital and 30-day mortality were 6.9% and 7.7%, respectively. Thirty-day Short Form-36 assessment showed a decrease in quality of life in five of ten items after the intervention. Receiver operating characteristic curves showed that the FORECAST is a valid tool to predict in-hospital mortality (area under the receiver operating characteristic curve, 0.73). By combining the FORECAST and the STS score, this effect was even higher (area under the receiver operating characteristic curve, 0.77; P = 0.021). Stratifying the patients according to the FORECAST score showed best survival in the lowest frailty group. Conclusions The FORECAST is a valid tool to assess frailty in TAVR patients. The FORECAST is easily assessable and can be included in daily clinical routine.

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<p>Under climate change, shifting  weather conditions, (both in terms of increasing frequency and intensifying magnitude) result in increasing occurrence of catastrophic failures of the constantly exposed and ageing infrastructure, across the world. Energetic flow events, advected past hydraulic infrastructure (such as bridge piers and abutments), may lead to scour [1, 2, 3], which is the primary cause of bridge collapses, resulting in high socio-economical costs, including loss of life.</p><p>This research aims to demonstrate the use of a novel monitoring device for the assessment of scour initiated by turbulent flows. This is pursued via the use of a miniaturized instrumented particle, namely “smart-sphere”, to record directly the frequency of entrainment from its downstream placement a model bridge pier at the Water Engineering lab of the University of Glasgow [4, 5, 6]. The change in entrainment frequencies is used as a metric to assess the increasing risk to scour, with increasing flow conditions, recorded acoustic Doppler velocimetry (ADV). The utility of the method as well as the potential use of the acquired data for prediction of bridge pier scour is presented and the tool as well is discussed with the potential for use to an appropriate field site [7, 8, 9].</p><p> </p><p>Acknowledgments</p><p>This research project has been supported by Transport Scotland, under the 2019/20 Innovation Fund and the Student research award.</p><p> </p><p>References</p><p>[1] Pähtz, Th., Clark, A., Duran, O., Valyrakis, M. 2019. The physics of sediment transport initiation, cessation and entrainment across aeolian and fluvial environments, Reviews of Gephysics, https://doi.org/10.1029/2019RG000679.</p><p>[2] Yagci, O., Celik, F., Kitsikoudis, V., Kirca, O., Hodoglu, C., Valyrakis, M., Duran, Z., Kaya S. 2016. Scour patterns around individual vegetation elements, Advances in Water Resources, 97, pp 251-265, doi: 10.1016/j.advwatres.2016.10.002.</p><p>[3] Michalis, P., Saafi, M. and M.D. Judd. (2012) Integrated Wireless Sensing Technology for Surveillance and Monitoring of Bridge Scour. Proceedings of the 6th International Conference on Scour and Erosion, France, Paris, pp. 395-402.</p><p>[4] Valyrakis, M. & Pavlovskis, E. 2014. "Smart pebble” design for environmental monitoring applications, In Proceedings of the 11th International Conference on Hydroinformatics, Hamburg, Germany.</p><p>[5] Valyrakis M., A. Alexakis. 2016. Development of a “smart-pebble” for tracking sediment transport. International Conference on Fluvial Hydraulics River Flow 2016, St. Liouis, MO, 8p.</p><p>[6] Valyrakis, M., Farhadi, H. 2017. Investigating coarse sediment particles transport using PTV and “smart-pebbles” instrumented with inertial sensors, EGU General Assembly 2017, Vienna, Austria, 23-28 April 2017, id. 9980.</p><p>[7] Valyrakis, M., Diplas, P., Dancey, C.L. 2011. Prediction of coarse particle movement with adaptive neuro-fuzzy inference systems, Hydrological Processes, 25 (22). pp. 3513-3524. ISSN 0885-6087, doi:10.1002/hyp.8228.</p><p>[8] Valyrakis, M., Michalis, P., Zhang, H. 2015a. A new system for bridge scour monitoring and prediction. Proceedings of the 36th IAHR World Congress, The Hague, the Netherlands, pp. 1-4.</p>