Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

Mourik, Martijn S. van; Velu, Juliëtte F.; Lanting, V. R.; Limpens, Jacqueline; Bouma, Berto J.; Piek, Jan J.; Baan, Jan; Henriques, José P.S.; Vis, Marije M.

doi:10.1007/s12471-020-01379-0

Cited by 12 publications

(15 citation statements)

References 71 publications

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“…In addition to 1-year hs-TnT and NT-proBNP levels, we also identified COPD and male sex as independent risk factors for long-term mortality after TAVR. Our findings are consistent with previous studies that have shown that COPD is associated with an increased risk of short-and long-term mortality after TAVR [33][34][35][36]. Previous studies on gender differences in outcomes after TAVR have produced conflicting results, but meta-analyses suggest that female gender may be independently associated with better mid-term survival (0.5-1 years) [37][38][39].…”

Section: Discussionsupporting

confidence: 91%

Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

et al. 2020

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Background Elevated pre-procedural high-sensitivity troponin T (hs-TnT) levels predict adverse outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). It is unknown whether elevated troponin levels still provide prognostic information during follow-up after successful TAVR. We evaluated the long-term implications of elevated hs-TnT levels found at 1-year post-TAVR. Methods and results The study included 349 patients who underwent TAVR for severe AS from 2010–2019 and for whom 1-year hs-TnT levels were available. Any required percutaneous coronary interventions were performed > 1 week before TAVR. The primary endpoint was survival time starting at 1-year post-TAVR. Optimal hs-TnT cutoff for stratifying risk, identified by ROC analysis, was 39.4 pg/mL. 292 patients had hs-TnT < 39.4 pg/mL (median 18.3 pg/mL) and 57 had hs-TnT ≥ 39.4 pg/mL (median 51.2 pg/mL). The high hs-TnT group had a higher median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, greater left ventricular (LV) mass, higher prevalence of severe diastolic dysfunction, LV ejection fraction < 35%, severe renal dysfunction, and more men compared with the low hs-TnT group. All-cause mortality during follow-up after TAVR was significantly higher among patients who had hs-TnT ≥ 39.4 pg/mL compared with those who did not (mortality rate at 2 years post-TAVR: 12.3% vs. 4.1%, p = 0.010). Multivariate analysis identified 1-year hs-TnT ≥ 39.4 pg/mL (hazard ratio 2.93, 95% CI 1.91–4.49, p < 0.001), NT-proBNP level > 300 pg/mL, male sex, an eGFR < 60 mL/min/1.73 m2 and chronic obstructive pulmonary disease as independent risk factors for long-term mortality after TAVR. Conclusions Elevated hs-TnT concentrations at 1-year after TAVR were associated with a higher long-term mortality. Graphic abstract

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Section: Discussionsupporting

confidence: 91%

Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

et al. 2020

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“…Van Mourik et al performed a meta-analysis that included 49 observational studies and identified a series of preoperative factors characteristic of frailty with prognostic value in TAVI [11]. These factors are preoperative chronic lung disease, chronic kidney disease (CKD), underweight (BMI < 20 kg/m 2 ), hypoalbuminemia, frailty according to frailty score, anemia, gait speed, and ADL (activities of daily living) independence.…”

Section: Discussionmentioning

confidence: 99%

Surgical versus Transvalvular Aortic Valve Replacement in Elderly Patients—The Impact of Frailty

et al. 2021

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(1) Background: The aging process leads to an increased number of patients with cardiovascular diseases that require surgical treatment. One of the most common heart diseases with an increased prevalence in the elderly is aortic stenosis (AS). Recently, transcatheter aortic valve implantation (TAVI) has become the preferred technique for frail patients with high surgical risk. Currently, there is no gold standard method for assessing frailty. The available scores are objective, but limited by the lack of prospective information, especially from patients undergoing cardiac surgery or interventional procedures. Moreover, the current frailty scores record only certain aspects of the frailty identified in some system and organs. The aims of this study were to evaluate the different profile patients treated with TAVI or with surgical aortic valve replacement (SAVR) and to analyze the risk factors of unfavorable outcomes in the two groups to identify potential factors for frailty that could be included in the new scoring system. (2) Methods: This study included patients over 65 years old evaluated with severe, symptomatic AS treated with TAVI or SAVR admitted to the Cardiovascular Diseases Institute, Iasi. (3) Results: The group included 88 patients treated with TAVI compared with 218 patients undergoing SAVR. Most of the TAVI patients (84.09%) were over 70 years compared to 30.09% of the SAVR group. The TAVI patients had an increased surgical risk assessed by EuroSCORE II (15 vs. 4%) and severe heart failure (NYHA IV, 36.36 vs. 6.48%). The only residual symptom was dyspnea, in a significantly lower prevalence compared to preoperative evaluation. (4) Conclusions: TAVI improves the general status with results comparable to SAVR in elderly patients with increased severity of the disease and higher prevalence of comorbidities.

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“…Two meta-analyses demonstrated that frailty is an independent predictor of mortality at ≤30 days (HR 2.35; 95% CI [1.78–3.09]), >30 day (HR 1.63; 95% CI [1.34–1.97]) and at 1 year (HR 2.16, 95% CI [1.57–3.00]). [ 65 , 66 ] Frailty also predicts functional decline post-TAVI (OR 1.82; 95% CI [1.14–2.91]). [ 67 ]…”

Section: Frailty and Related Conditions Affecting Tavi Outcomesmentioning

confidence: 99%

“…In addition, assessing disability and independence using validated tools, such as the Rockwood Clinical Frailty Score and the Katz index, although semi-quantitative tools, can provide quick and important prognostic data for TAVI patients. [ 66 , 99 , 100 ] Interventions to improve frailty and their impact on outcomes are ongoing, limiting the role of comprehensive frailty assessment to risk stratification rather than therapeutic interventions (NCT03107897 and NCT0352245). [ 101 , 102 ]…”

Section: Risk Assessment For High-risk Patientsmentioning

confidence: 99%

Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity

et al. 2022

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Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.

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Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

Cited by 12 publications

References 71 publications

Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

Surgical versus Transvalvular Aortic Valve Replacement in Elderly Patients—The Impact of Frailty

Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity

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