Frailty as a Dynamic Measure for the Assessment of Aortic Valve Intervention

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 [ ]. The members of a “Heart Team” vary between institutions, but there is an increasing involvement of geriatricians reflecting the ageing population. Frailty is a clinical syndrome characterised by multi-system impairment that decreases physiological reserve and increases vulnerability to stress [ , ]. However, there is no standardisation of frailty measurement and different frailty scoring systems tend to use various physical measures along with age and co-morbidities. A recent systematic review of 66,448 patients who underwent cardiac surgery showed that 37% of patients had undergone an objective test, such as walking velocity or the 6-minute walk test. The remaining 63% underwent a broad range of frailty scoring systems with the most common being the Fried/Modified Fried (25%) [ ]. Frailty has been demonstrated to increase the risk of almost all complications of cardiac surgery [ ].