The Impact of Frailty Status on Survival After Transcatheter Aortic Valve Replacement in Older Adults With Severe Aortic Stenosis

Abstract

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.

Frailty and perioperative outcomes: a narrative review

“…Four studies involved patients having cardiac valve surgery (including transcatheter aortic valve repplacement). 4,[22][23][24] Five studies involved a mix of gastrointestinal surgical patients, [25][26][27] including abdominal 21 and other general surgery patients. 28 Two studies involved vascular surgical patients 29,30 and two involved surgical oncology patients with either gynecological neoplasms 31 or gastric adenocarcinoma.…”

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

“…It is associated with increased mortality, surgical site infections, length of hospital stay, increased healthcare expenditure, and readmission rates in patients presenting for a variety of major noncardiac surgeries 8, 9, 10, 11, 12. Frailty has also been reported as a risk factor for mortality, major adverse cardiac and cerebrovascular events, and increased length of hospital stay in cardiac surgical patients 1, 2, 13, 14, 15, 16. The cardiac surgery literature consists primarily of relatively small single‐center studies with limited follow‐up durations, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.…”

Impact of frailty markers on outcomes after transcatheter aortic valve replacement: insights from a Japanese multicenter registry

“…In the 2014 AHA/ACC guideline for VHD, the Katz index and gait speed have been recommended as good assessment tools of patient frailty (3), although there are no standardized criteria for measuring patient frailty. Recently, several studies on a cohort of patients who underwent TAVR reported that patient frailty is strongly associated with long-term prognosis (4,5). However, all these studies were performed in a small number of patients at a single center.…”