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Heart, Lung and Circulation

Impact of Surgical and Transcatheter Aortic Valve Replacement on Frailty Score

Published:October 13, 2021DOI:https://doi.org/10.1016/j.hlc.2021.09.014

      Objective

      Frailty is common in the aortic stenosis (AS) population and impacts outcomes after both transcatheter and surgical aortic valve replacement (TAVR and sAVR, respectively). Frailty can significantly impact the decision regarding the suitability of a patient for aortic valve intervention, with frail patients often excluded. Since many frailty tools use indicators which may be influenced by AS itself, some of which are subjectively symptom driven, we sought to determine the impact of intervention on frailty scores.

      Methods

      A prospective, observational cohort study included patients being assessed for aortic valve (AV) intervention with either TAVR or sAVR due to severe aortic stenosis. Patients were assessed for symptoms at baseline, and 1- and 6-months post intervention subjectively, using the New York Heart Association (NYHA) class and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and objectively, using a 6-minute walk test (6MWT). These were compared with frailty at baseline and final review using the Fried Frailty Scale (FFS).

      Results and Conclusions

      Sixty-six (66) patients completed pre- and post-intervention reviews. The mean FFS score was significantly lower, indicating less frailty, at 6 months relative to pre procedure (1.18 vs 1.73, p=0.002). This correlated with the change in symptoms (p<0.001). Between intervention groups, the final mean FFS of both groups decreased significantly, with TAVR to 1.33 (p=0.030) and sAVR to 0.8 (p=0.015). There was no difference in the degree of improvement between interventions (p=0.517). Aortic valve intervention improves frailty scores in both TAVR and sAVR treated patients.

      Keywords

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      References

        • Bonow R.O.
        • Greenland P.
        Population-wide trends in aortic stenosis incidence and outcomes.
        Circulation. 2015; 131: 969-971
        • Afilalo J.
        • Alexander K.P.
        • Mack M.J.
        • Maurer M.S.
        • Green P.
        • Allen L.A.
        • et al.
        Frailty assessment in the cardiovascular care of older adults.
        J Am Coll Cardiol. 2014; 63: 747-762
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Fleisher L.A.
        • et al.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        Circulation. 2017; 135: e1159-e1195
        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • et al.
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Cribier A.
        • Eltchaninoff H.
        • Bash A.
        • Borenstein N.
        • Tron C.
        • Bauer F.
        • et al.
        Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.
        Circulation. 2002; 106: 3006-3008
        • Baumgartner H.
        • Falk V.
        • Bax J.J.
        • De Bonis M.
        • Hamm C.
        • Holm P.J.
        • et al.
        2017 ESC/EACTS guidelines for the management of valvular heart disease.
        Eur Heart J. 2017; 38: 2739-2791
        • Afilalo J.
        • Lauck S.
        • Kim D.H.
        • Lefevre T.
        • Piazza N.
        • Lachapelle K.
        • et al.
        Frailty in older adults undergoing aortic valve replacement: The FRAILTY-AVR study.
        J Am Coll Cardiol. 2017; 70: 689-700
        • Green P.
        • Arnold S.V.
        • Cohen D.J.
        • Kirtane A.J.
        • Kodali S.K.
        • Brown D.L.
        • et al.
        Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial).
        Am J Cardiol. 2015; 116: 264-269
        • Talbot-Hamon C.
        • Afilalo J.
        Transcatheter aortic valve replacement in the care of older persons with aortic stenosis.
        J Am Geriatr Soc. 2017; 65: 693-698
        • Sepehri A.
        • Beggs T.
        • Hassan A.
        • Rigatto C.
        • Shaw-Daigle C.
        • Tangri N.
        • et al.
        The impact of frailty on outcomes after cardiac surgery: a systematic review.
        J Thorac Cardiovasc Surg. 2014; 148: 3110-3117
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        Frailty in older adults evidence for a phenotype. Frailty in older adults evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Arnold S.V.
        • Spertus J.A.
        • Vemulapalli S.
        • Dai D.
        • O'Brien S.M.
        • Baron S.J.
        • et al.
        Association of patient-reported health status with long-term mortality after transcatheter aortic valve replacement: report from the STS/ACC TVT Registry.
        Circ Cardiovasc Interv. 2015; 8: e002875
        • Savva G.M.
        • Donoghue O.A.
        • Horgan F.
        • Regan C.O.
        • Cronin H.
        • Kenny R.A.
        Using timed up-and-go to identify frail members of the older population.
        J Gerontol A Biol Sci Med Sci. 2012; 68: 441-446
        • Alfredsson J.
        • Stebbins A.
        • Brennan J.M.
        • Matsouaka R.
        • Afilalo J.
        • Peterson E.D.
        • et al.
        Gait Speed predicts 30-day mortality after transcatheter aortic valve replacement: results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
        Circulation. 2016; 133: 1351-1359
        • Nancye M.P.
        • Suzanne S.K.
        • Kerenaftali K.
        Gait speed as a measure in geriatric assessment in clinical settings: a systematic review.
        J Gerontol A Biol Sci Med Sci. 2013; 68: 39-46
        • Arnold S.V.
        • Spertus J.A.
        • Lei Y.
        • Allen K.B.
        • Chhatriwalla A.K.
        • Leon M.B.
        • et al.
        Use of the Kansas City Cardiomyopathy Questionnaire for monitoring health status in patients with aortic stenosis.
        Circ Heart Fail. 2013; 6: 61-67
        • Arsalan M.
        • Khan S.
        • Golman J.
        • Szerlip M.
        • Mahoney C.
        • Herbert M.
        • et al.
        Balloon aortic valvuloplasty to improve candidacy of patients evaluated for transcatheter aortic valve replacement.
        J Interv Cardiol. 2018; 31: 68-73
        • Afilalo J.
        The PERFORM-TAVR Trial.
        (Clinicaltrials.gov. Available at:)
        https://clinicaltrials.gov/ct2/show/NCT03522454
        Date: 2020
        Date accessed: August 5, 2020

      Linked Article

      • Frailty as a Dynamic Measure for the Assessment of Aortic Valve Intervention
        Heart, Lung and CirculationVol. 31Issue 4
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          The candidacy of patients for major cardiac interventions is based on assessment of their co-morbidities and physical status. As the population ages, older patients with significant medical problems present with potentially correctable cardiovascular conditions. The “Heart Team” approach with multidisciplinary discussions has become the standard of care in most institutions to identify patients who are suitable for intervention and are reflected in recent guidelines [1]. The members of a “Heart Team” vary between institutions, but there is an increasing involvement of geriatricians reflecting the ageing population.
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