Prevalence and Prognostic Implications of Frailty in Transcatheter Aortic Valve Replacement

Piankova, Palina; Afilalo, Jonathan

doi:10.1016/j.ccl.2019.09.011

Cited by 10 publications

(19 citation statements)

References 81 publications

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“…However, the frailty prevalence in this study corresponded to the prevalence range (29%-63%) of frailty in patients undergoing TAVI that was found in a recent meta-analysis. 34 Finally, during the 3-month follow-up appointment with the geriatric nurse practitioner, patients were often not explicitly asked if they had been readmitted to a hospital within 3 months of TAVI. This may lead to an underestimation of the number of participants with a readmission if a patient was admitted to a hospital other than the University Medical Centre Utrecht.…”

Section: Discussionmentioning

confidence: 99%

Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

et al. 2021

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ObjectiveIn recent years, transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with symptomatic aortic valve stenosis considered to be at increased or high surgical risk. The aim of this study was to identify predictors of postoperative adverse events in older adults undergoing TAVI.MethodsA prospective observational cohort study of patients who were referred to a geriatric outpatient clinic for a geriatric assessment prior to TAVI was conducted. The outcomes were mortality and hospital readmission within 3 months of TAVI and the occurrence of major postoperative complications during hospitalisation according to the Clavien-Dindo classification. These three outcomes were also combined to a composite outcome. Univariate and multivariate logistic regression analyses were performed to identify predictors of the outcomes and composite outcome of adverse events.ResultsThis cohort included 490 patients who underwent TAVI (mean age 80.7±6.2 years, 47.3% male). Within 3 months of TAVI, 19 (3.9%) patients died and 46 (9.4%) patients experienced a hospital readmission. A total of 177 (36.1%) patients experienced one or more major complications according to the Clavien-Dindo classification during hospitalisation and 193 patients (39.4%) experienced the composite outcome of adverse events. In multivariate analyses, cognitive impairment was identified as an independent predictor of major postoperative complications (OR 2.16; 95% CI 1.14 to 4.19) and the composite outcome of adverse events (OR 2.40; 95% CI 1.21 to 4.79). No association was found between the other variables and the separate outcomes and composite outcome.ConclusionCognitive impairment is associated with postoperative adverse events in older patients undergoing TAVI. Therefore, it is important to screen for cognitive impairment prior to TAVI and it is recommended to include this in current TAVI guidelines.

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Section: Discussionmentioning

confidence: 99%

Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

et al. 2021

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“…Therefore, it is important to identify risk factors that predict adverse outcomes of TAVR. Prior research has indicated that preoperative frailty is a strong predictor of 30‐day mortality and late mortality among patients undergoing TAVR 7,8 . Frailty is commonly defined as a “biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, and causing vulnerability to adverse outcomes.” 9 Postoperative delirium is frequently observed following TAVR and often leads to a prolonged hospital stay and increased mortality 10,11 .…”

Section: Introductionmentioning

confidence: 99%

The impact of frailty on adverse outcomes after transcatheter aortic valve replacement in older adults: A retrospective cohort study

Dautzenberg

Aarle

Stella

et al. 2022

Cathet Cardio Intervent

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Background: Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement for patients who are at increased surgical risk. Consequently, frailty is common in patients undergoing TAVR.Objectives: This study aims to investigate the impact of frailty on outcomes following TAVR.Methods: A retrospective cohort study was conducted, including all TAVR candidates who visited the geriatric outpatient clinic for preoperative screening.Frailty status was assessed according to the Groningen Frailty Indicator. The primary outcome of the study was defined as the occurrence of postoperative complications, and this was evaluated according to the Clavien-Dindo classification. An additional analysis was performed to assess the impact of frailty on 1-year all-cause mortality and complications within 30 days of TAVR according to the Valve Academic Research Consortium (VARC-2) criteria. The VARC-2 criteria provide harmonized endpoint definitions for TAVR studies.Results: In total, 431 patients with a mean age of 80.8 ± 6.2 years were included, of whom 56% were female. Frailty was present in 36% of the participants. Frailty was associated with a higher risk of the composite outcome of complications [adjusted odds ratio (OR): 1.

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“…Despite significant advances in valve design and delivery techniques, TAVR remains associated with numerous complications such as paravalvular leak, stroke, and vascular access site bleeding 3‐5 . The majority of TAVR candidates are elderly patients with pre‐existing comorbidities that offset the procedure's long‐term prognosis 6 . In particular, the prevalence of anemia increases with age and is associated with poor outcomes following various cardiovascular procedures 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry

Nicolas

Claessen

Cao

et al. 2020

Cathet Cardio Intervent

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Objectives To assess the impact of anemia on clinical outcomes in female patients enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN‐TAVI) registry. Background Anemia is highly prevalent among females who constitute half of TAVI candidates, yet, its clinical significance remains poorly investigated. Methods Patients were divided into three groups according to preprocedural hemoglobin (Hb) level: (1) no anemia (Hb ≥12 g/dl), (2) mild‐to‐moderate anemia (10 ≤ Hb <12 g/dl), and (3) severe anemia (Hb <10 g/dl). The primary outcome was the occurrence of Valve Academic Research Consortium (VARC)‐2 efficacy endpoint, a composite of mortality, stroke, myocardial infarction (MI), hospitalization for valve‐related symptoms or heart failure or valve‐related dysfunction at 1‐year follow‐up. Results Hemoglobin level was available in 877 (86.1%) patients: 412 (47.0%) had no anemia, 363 (41.4%) had mild‐to‐moderate anemia, and 102 (11.6%) had severe anemia. The latter group had a higher prevalence of cardiovascular risk factors. Compared with patients without anemia, severe anemia was associated with a greater risk of VARC‐2 efficacy endpoint (adjHR 1.71, 95% CI: 1.02–2.87, p = .04), all‐cause death (adjHR 2.36, 95% CI: 1.31–4.26, p = .004) and a composite of death, MI or stroke (adjHR 1.88, 95% CI: 1.10–3.22, p = .02) at 1 year. Moreover, an increased risk of late mortality (adjHR 1.15, 95% CI: 1.02–1.30, p = .03) was observed with every 1 g/dl decrease in hemoglobin level. Conclusion Severe anemia in females undergoing TAVI was independently associated with increased rates of VARC‐2 efficacy endpoint and mortality at 1 year.

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Prevalence and Prognostic Implications of Frailty in Transcatheter Aortic Valve Replacement

Cited by 10 publications

References 81 publications

Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

The impact of frailty on adverse outcomes after transcatheter aortic valve replacement in older adults: A retrospective cohort study

Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry

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