Transcatheter Aortic Valve Replacement in the Care of Older Persons with Aortic Stenosis

Talbot-Hamon, Catherine; Afilalo, Jonathan

doi:10.1111/jgs.14776

Cited by 16 publications

(8 citation statements)

References 48 publications

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“… 5 Frailty is a geriatric syndrome influencing potential functional recovery after a TAVI or SAVR procedure. 6 , 7 Although the likelihood of short-term procedural success exceeds 95%, 8 2 of 5 patients in the PARTNER I (Placement of AoRTic TraNscathetER Valve Trial) and CoreValve Pivotal trials experienced poor health-related quality of life or death over the ensuing year. 9 To optimize patient selection for a certain treatment of aortic valve stenosis, national guidelines strongly recommend an objective evaluation of frailty.…”

Section: Introductionmentioning

confidence: 99%

Functionality and Outcome in Older Patients with Severe Aortic Stenosis (FOOPAS): an interdisciplinary study concept for a prospective trial

Vogt

Wicklein

Gosch

et al. 2018

CIA

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BackgroundFrailty is a geriatric syndrome that can influence mortality and functional recovery after treatment of severe aortic stenosis (AS). The integration of standardized geriatric assessment (GA) in clinical practice is limited by a lack of consensus on how to measure it.ObjectivesThis study aims to compare the incremental predictive value of different frailty scales to predict the outcomes following surgical aortic valve replacement, transcatheter aortic valve implantation, and conservative treatment of severe AS.MethodsA prospective cohort of 300 older adults with severe AS will be assembled after standard clinical examinations and a comprehensive GA, including 18 different tests and values. Primary outcome parameters are overall mortality, cardiovascular mortality, quality of life, and functionality. Secondary parameters are overall complications, cardiovascular complications, and costs.ResultsExpected results will contribute to the growing body of evidence on frailty based on parameters that influence clinical and functional outcome in elderly patients independent of the method of treatment. The pre-procedural assessment is expected to be valuable in discriminating new post-procedural complications from simple exacerbations of pre-existing conditions. Therefore, a new frailty test which is simple and feasible for application in a clinical routine by most medical professionals, may help in identifying patients for whom further GA should be considered. Finally, such a frailty score could support heart teams to find the right treatment for patients suffering from AS.ConclusionComparison of different frailty scales has not only the goal of finding a predictive value of mortality but also to bring in a meaningful improvement for each individual patient and to avoid disability or fatal outcomes.

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Section: Introductionmentioning

confidence: 99%

Functionality and Outcome in Older Patients with Severe Aortic Stenosis (FOOPAS): an interdisciplinary study concept for a prospective trial

Vogt

Wicklein

Gosch

et al. 2018

CIA

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“…This parameter becomes of great interest in cancer patients, who can be frail due to their cancer treatments, despite having a favorable oncologic prognosis [63,64]. Although there are multiple instruments that can be used to measure frailty and this parameter has been related to increased post-AVR mortality [65,66], there are no guideline recommendations regarding frailty and TAVR or SAVR in cancer patients. General recommendations to assess physical performance, disability regarding activities of daily living, cognitive function, hemoglobin, and albumin as part of the evaluation of older adults with severe AS [66][67][68] can be considered in cancer patients as well.…”

Section: Tavr In Cancer Patientsmentioning

confidence: 99%

“…Although there are multiple instruments that can be used to measure frailty and this parameter has been related to increased post-AVR mortality [65,66], there are no guideline recommendations regarding frailty and TAVR or SAVR in cancer patients. General recommendations to assess physical performance, disability regarding activities of daily living, cognitive function, hemoglobin, and albumin as part of the evaluation of older adults with severe AS [66][67][68] can be considered in cancer patients as well. The FRAILTY-AVR study, one of the largest studies evaluating the impact of frailty indices in patients undergoing TAVR and SAVR, included 151 (15%) patients with cancer [67].…”

Section: Tavr In Cancer Patientsmentioning

confidence: 99%

The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?

et al. 2019

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Purpose of Review Aging is associated with an increased prevalence of both cancer and heart disease. The progression of aortic valve calcification to aortic stenosis may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy with mediastinal involvement. Symptomatic aortic stenosis is occasionally diagnosed in cancer patients undergoing cardiovascular evaluation; likewise, cancer is often recognized during assessment preceding aortic valve interventions. In these complex cases, physicians face difficult treatment decisions. Due to a myriad of clinical presentations of cancer and valve disease, specific guidelines for this patient population are not currently in place. Management is currently based on clinical judgment, on an individual basis. Recent Findings Patients with cancer in remission or with a favorable prognosis should be treated according to current cardiovascular guidelines. In these patients, aortic valve replacement can be performed either by surgery or transcatheter. Significant challenges arise in patients with active cancer, especially those receiving anti-cancer treatment. Recent data suggests that these patients can be offered aortic valve replacement, with a trend of favoring the transcatheter route in order to minimize perioperative This article is part of the Topical Collection on Cardio-Oncology

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“…Given these considerations surrounding gait speed, its role may be described as a convenient screening test for frailty that can be used to flag vulnerable patients in need of further evaluation. 12 Beyond the details of this study's strengths and limitations, it is notable that amid the mounting flood of frailty studies, broader application of frailty assessment and management has lagged as a standard of care. This contrasts strongly with the relatively more rapid integration of other diagnostic and prognostic metrics soon after they were recognized (eg, calcium score).…”

Section: Afilalo and Forman Gait Speed And Frailty In Tavr Candidatesmentioning

confidence: 99%

Gait Speed Assessment in Transcatheter Aortic Valve Replacement

Afilalo

Forman

2017

Circ: Cardiovascular Interventions

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Transcatheter Aortic Valve Replacement in the Care of Older Persons with Aortic Stenosis

Cited by 16 publications

References 48 publications

Functionality and Outcome in Older Patients with Severe Aortic Stenosis (FOOPAS): an interdisciplinary study concept for a prospective trial

Functionality and Outcome in Older Patients with Severe Aortic Stenosis (FOOPAS): an interdisciplinary study concept for a prospective trial

The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?

Gait Speed Assessment in Transcatheter Aortic Valve Replacement

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