Role of comprehensive geriatric assessment in low surgical risk older patients with aortic stenosis

[Percutaneous aortic valve replacement: outcome of patients evaluated by EMG at Toulouse University Hospital preprocedure]

Transcatheter Aortic Valve Implantation has become the preferred method of aortic valve replacement in the elderly. Preoperative standardized geriatric assessment (SGA) helps guide the decision to proceed, taking into account geriatric parameters not targeted by surgical risk scores. This is a descriptive, retrospective study of patients who underwent EGS at the Toulouse University Hospital, analyzing their length of stay and postoperative care pathway.

Evolution of Basic Activities of Daily Living Function in Older Patients One Year After Transcatheter Aortic Valve Implantation

BACKGROUND/OBJECTIVES

To assess the course and prediction of basic activities of daily living (ADL) function in patients after transcatheter aortic valve implantation (TAVI).

DESIGN

This was a prospective cohort study.

SETTING

The setting was a single academic center in Switzerland.

PARTICIPANTS

Participants included individuals aged ≥70 years (n = 330) undergoing TAVI.

MEASUREMENTS

A frailty index (based on geriatric assessment) and cardiac risk scores (EuroSCORE, Society of Thoracic Surgeons [STS] score) were determined in patients before TAVI. Basic ADL function was measured with patient or proxy interviews at baseline and 1-year follow up. We used logistic regression models to investigate the association between baseline factors and functional decline.

RESULTS

At 1-year follow up, 229 (69.4%) of the 330 patients had stable or improved basic ADL function, 49 (14.8%) experienced a decline in basic ADL function, and 52 (15.8%) died. The frailty index, but not cardiac risk scores, significantly predicted decline in basic ADL function. Among the 34 surviving very frail patients, 12 (35.3%) experienced a functional status decline, and the remaining 22 (64.7%) had stable or improved functional status at 1-year follow up.

CONCLUSION

This study confirms that a frailty index, and not cardiac risk scores, identifies patients at an increased risk of functional status decline after TAVI. Identifying patients with a high frailty index before TAVI is clinically relevant as these patients might benefit from targeted geriatric management and rehabilitation after TAVI. However, based on current data, it is not justified to use information on frailty status as the criterion for identifying patients in whom TAVI might be futile. Although the probability of poor outcome is high, very frail patients also have a high probability of favorable long-term functional outcome.