Objectives This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for symptomatic aortic stenosis. Background Frailty status impacts prognosis in older adults with heart disease; however, the impact of frailty on prognosis after TAVR is unknown. Methods Gait speed, grip strength, serum albumin, and activities of daily living status were collected at baseline and used to derive a frailty score among patients who underwent TAVR procedures at a single large-volume institution. The cohort was dichotomized on the basis of median frailty score into frail and not frail groups. The impact of frailty on procedural outcomes (stroke, bleeding, vascular complications, acute kidney injury, and mortality at 30 days) and 1-year mortality was evaluated. Results Frailty status was assessed in 159 subjects who underwent TAVR (age 86 ± 8 years, Society of Thoracic Surgery Risk Score 12 ± 4). Baseline frailty score was not associated with conventionally ascertained clinical variables or Society of Thoracic Surgery score. Although high frailty score was associated with a longer post-TAVR hospital stay when compared with lower frailty score (9 ± 6 days vs. 6 ± 5 days, respectively, p = 0.004), there were no significant crude associations between frailty status and procedural outcomes, suggesting adequacy of the standard selection process for identifying patients at risk for periprocedural complications after TAVR. Frailty status was independently associated with increased 1-year mortality (hazard ratio: 3.5, 95% confidence interval: 1.4 to 8.5, p = 0.007) after TAVR. Conclusions Frailty was not associated with increased periprocedural complications in patients selected as candidates to undergo TAVR but was associated with increased 1-year mortality after TAVR. Further studies will evaluate the independent value of this frailty composite in older adults with aortic stenosis.

Transcatheter aortic valve replacement (TAVR) is an effective treatment for severe symptomatic aortic stenosis (AS) in patients who are inoperable or at high risk for surgery. However, the intermediate to long-term mortality is high, emphasizing the importance of patient selection. We therefore sought to evaluate the prognostic value of frailty among older TAVR recipients, hypothesizing that frail patients would experience a higher mortality rate and a higher likelihood of poor outcome 1 year after TAVR. This substudy of the PARTNER (Placement of AoRtic TraNscathetER Valves) Trial was conducted at 3 high-enrolling sites where frailty was assessed systematically prior to TAVR. In total, 244 patients received TAVR at the participating sites. Frailty was assessed using a composite of four markers (serum albumin, dominant hand grip strength, gait speed, and Katz activity of daily living (ADLs) survey), which were combined into a frailty score. The cohort was dichotomized at median frailty score. Outcomes measures were the time to death from any cause over 1 year of follow up and poor outcome at one year. Poor outcome was defined as: (1) death, (2) Kansas City Cardiomyopathy Questionnaire – Overall Summary score (KCCQ-OS) <60, or (3) decrease of ≥10 points in the KCCQ-OS score from baseline to 1 year. At 1 year, the Kaplan-Meier estimated all-cause mortality rate was 32.7% in the frail group and 15.9% in the non-frail group (log-rank p=0.004). At 1 year, poor outcome occurred in 50.0% of the frail group and 31.5% of the non-frail group (p=0.02). In conclusion, Frailty was associated with increased mortality and a higher rate of poor outcome 1 year after TAVR. Clinical Trial Registration: ClinicalTrials.gov, Unique Identifier # NCT00530894