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Schwesinger A, Tsai LT, Lang W, Mantegazza N, Bauernschmitt R, Wilhelm MJ, Bischoff-Ferrari HA, Gagesch M. Does Comprehensive Geriatric Assessment Reduce the Incidence of Postoperative Delirium? A Quasi-experimental Study in Older Adults Undergoing Transcatheter Aortic Valve Implantation. Clin Interv Aging 2024; 19:347-355. [PMID: 38434577 PMCID: PMC10909326 DOI: 10.2147/cia.s448167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement. Patients and methods We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications. Results Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (P 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65-2.04) or improved SPI (P 0.073). Conclusion We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.
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Affiliation(s)
- Anna Schwesinger
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Li-Tang Tsai
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Wei Lang
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Noemi Mantegazza
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | | | | | - Heike Annette Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
- IHU HealthAge, University Hospital Toulouse and University Toulouse III Paul Sabatier, Toulouse, France
| | - Michael Gagesch
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
- Department of Aging Medicine, University Hospital Zurich, Zurich, Switzerland
- University Clinic of Aging Medicine, Zurich City Hospital, Zurich, Switzerland
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Spaccarotella CAM, Sorrentino S, Mongiardo A, Riverso V, Mancuso C, Giordano S, Esposito G, Indolfi C. Acute expansion of nitinol-based self-expandable device in patients undergoing transfemoral aortic valve implantation. J Cardiovasc Med (Hagerstown) 2023; 24:308-312. [PMID: 36957987 DOI: 10.2459/jcm.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND The acute adaptation of the nitinol-based stent frame self expandable valve to the aortic root after deployment is poorly understood. Accordingly, this study aimed to assess the occurrence, degree and determinants of acute adaptation of the nitinol-based stent frame self-expandable valves after implantation. METHODS This is a single-site prospective registry including patients undergoing transcatheter aortic valve replacement (TAVR) with a widely used second-generation nitinol-based self-expandable device (Evolut R, Medtronic, Minneapolis, Minnesota, USA). We measured valve diameters at three different sections: distal (aortic) level, central (annulus) level and proximal (ventricular) level. Valve expansion was estimated by the difference between the diameters calculated immediately after valve deployment (A) and at the end of the procedure (B). The absolute and relative stent changes were defined as B-A and (B-A)/B∗100, respectively. A linear regression model was performed to test the association between the degree of valve extension at each segment with baseline and procedural characteristics. RESULTS A total of 58 consecutive TAVR patients were included in this analysis, with a mean age of 82.12 ± 5.28 years. Out of the total, 46% of the patients had chronic kidney disease, 32% had diabetes and 76% had dyslipidaemia. The mean procedural time was 28.11 ± 11.6 min, with 53.45% of predilation. Postdilation was performed only in 3.5% of patients. Final stent diameters were significantly higher than those achieved immediately after valve implantation - an observation that was consistent for all the segments: 0.50 ± 0.51 mm and 2.48 ± 2.57% (P < 0.01) in the proximal, 0.46 ± 0.57 mm and 2.39 ± 2.96% (P < 0.01) in the central, as well as 0.58 ± 0.59 mm and 2.14 ± 2.14% (P < 0.01) at the distal segments. Postdilation significantly affected the expansion of the central segment, and, albeit not significantly, the proximal one, while no changes were observed for the distal portion of the platform. CONCLUSION This is the first study to have documented a significant degree of the Evolut R self-expandable valve expansion after deployment. However, further studies are required to assess the short- and long-term time course of self-expandable valve enlargement and the clinical relevance of this finding.
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Affiliation(s)
- Carmen A M Spaccarotella
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Vincenzo Riverso
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Cinzia Mancuso
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Porterie J, Kalavrouziotis D, Dumont E, Paradis JM, De Larochellière R, Rodés-Cabau J, Mohammadi S. Clinical impact of the heart team on the outcomes of surgical aortic valve replacement among octogenarians. J Thorac Cardiovasc Surg 2023; 165:1010-1019.e5. [PMID: 33840473 DOI: 10.1016/j.jtcvs.2021.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/17/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The effectiveness of a multidisciplinary heart team in the management of patients with severe symptomatic aortic stenosis is unknown. This study evaluated the impact of a heart team on the outcomes of surgical aortic valve replacement in octogenarians. METHODS Between May 2007 and January 2016, 528 patients aged 80 years or more were referred to our institutional heart team for a transcatheter aortic valve replacement. Among these, 101 were redirected to surgical aortic valve replacement (heart team group). These patients were compared with a surgical aortic valve replacement cohort (n = 506) without prior heart team screening (non-heart team group), taken from the same time period. Propensity score matching with bootstrap analysis was performed; 76 heart team patients were matched to 76 non-heart team patients. Early and late outcomes including survival and readmission for cardiovascular causes were compared. RESULTS Matched subgroups were largely comparable; congestive heart failure and echocardiographic pulmonary hypertension were more prevalent in the heart team group. In-hospital mortality was significantly lower in the matched heart team group (0% vs 6.0%, bootstrap mean difference 6.0%, 95% confidence interval, 2.2-9.8). The risk of stroke, low cardiac output state, reexploration for bleeding, pneumonia, and prolonged ventilation was also significantly lower in the heart team group. There was no significant between-group difference regarding late survival (hazard ratio, 0.86, 95% confidence interval, 0.55-1.33, P = .49) or readmission for cardiovascular reasons (hazard ratio, 0.70, 95% confidence interval, 0.41-1.20, P = .19). CONCLUSIONS Preoperative multidisciplinary assessment of octogenarians by a heart team was associated with lower in-hospital mortality and adverse events after surgical aortic valve replacement.
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Affiliation(s)
- Jean Porterie
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Robert De Larochellière
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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4
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Solla-Suárez P, Avanzas P, Fernández-Fernández M, Pascual I, Moreno-Planillo C, Almendárez M, López-Álvarez E, Álvarez R, Coto-Montes A, Morís C, Gutiérrez-Rodríguez J. Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement. Aging Clin Exp Res 2023; 35:323-331. [PMID: 36417136 DOI: 10.1007/s40520-022-02300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The impact of functional capacity over the entire functional continuum in older adults undergoing aortic valve replacement (AVR) has not been studied to date. This study aims to analyze 1.- the distribution of a cohort of older adults presenting severe aortic stenosis (AS) amenable to AVR in the different categories of the Functional Continuum Scale (FCS); 2.- its association with decision-making regarding valve disease; and 3.- its impact upon the one-year mortality rate of surgical (SAVR), transcatheter (TAVR) aortic valve replacement, or the decision to provide conservative management (OMT). METHODS This prospective study included patients from the FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry evaluated by the reference Heart-Team of a region in northern Spain. All the patients underwent comprehensive geriatric assessment. RESULTS The study comprised 257 patients aged 84.0 ± 3.9 years. MANAGEMENT SAVR: 25.3%, TAVR: 58.0% and OMT: 16.7%. Increased patient functional capacity was associated with an increased tendency to perform more invasive valve disease treatment. The overall one-year survival rate was 81.3%. One-year all-cause mortality: FCS-1 to FCS-2 "robust" 11.5%, FCS-3 to FCS-4 "prefrail" 14.7%, FCS-5 "frail" 19.2% and FCS-6 to FCS-8 "dependent" 45.0%; p < 0.001. Adjusted mortality analysis: FCS with HR = 1.206 [95%CI, 0.999-1.451 (p = 0.051)]; EuroSCORE-II with HR = 1.071 [95%CI, 1.006-1.161 (p = 0.033)]; and OMT with HR = 2.840 [95%CI, 1.409-5.772 (p = 0.004)] were retained in the final multivariable logistic regression model. CONCLUSIONS In older AS patients amenable to AVR, the FCS is a useful predictive tool that may aid clinical decision-making.
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Affiliation(s)
- Pablo Solla-Suárez
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain. .,Health Research Institute of Asturias, ISPA, Oviedo, Spain.
| | - Pablo Avanzas
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain
| | - Marta Fernández-Fernández
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain
| | - Isaac Pascual
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain
| | - Carmen Moreno-Planillo
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain
| | - Marcel Almendárez
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain
| | - Eva López-Álvarez
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain
| | - Rut Álvarez
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain
| | - Ana Coto-Montes
- Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain.,Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
| | - César Morís
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain
| | - José Gutiérrez-Rodríguez
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain
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5
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van Beek-Peeters JJAM, van den Ende Z, Faes MC, de Vos AJBM, van Geldorp MWA, Van den Branden BJL, van der Meer BJM, Minkman MMN. Decision making in treatment of symptomatic severe aortic stenosis: a survey study in Dutch heart centres. Neth Heart J 2022; 30:423-428. [PMID: 35380417 PMCID: PMC9402830 DOI: 10.1007/s12471-022-01676-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting. Supplementary Information The online version of this article (10.1007/s12471-022-01676-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Z van den Ende
- Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
| | | | - M W A van Geldorp
- Department of Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - B J M van der Meer
- TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
- Board of Directors, Catharina Hospital, Eindhoven, The Netherlands
| | - M M N Minkman
- TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
- Vilans, Centre of Expertise for Long-term Care, Utrecht, The Netherlands
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6
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Ghezzi ES, Psaltis PJ, Loetscher T, Davis D, Montarello J, Lau JK, Delacroix S, Bourke A, McLoughlin J, Keage M, Keage HAD. Identifying New Factors Associated With Cognitive Decline and Delirium After Transcatheter Aortic Valve Implantation: A Study Protocol. Front Cardiovasc Med 2021; 8:657057. [PMID: 34458327 PMCID: PMC8385234 DOI: 10.3389/fcvm.2021.657057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the standard-of-care for treatment of severe symptomatic aortic stenosis and is also being increasingly recommended for low-risk patients. While TAVI boasts positive post-procedural outcomes, it is also associated with cognitive complications, namely delirium and cognitive decline. There is a pressing need for accurate risk tools which can identify TAVI patients at risk of delirium and cognitive decline, as risk scores designed for general cardiovascular surgery fall short. The present effect-finding exploratory study will assess the utility of various measures in the context of aging and frailty in predicting who will and who will not develop delirium or cognitive impairment following TAVI. The measures we propose include gait, visual symptoms, voice, swallowing, mood and sleep. Methods: This is an observational prospective cohort study focused on identifying pre-procedural risk factors for the development of delirium and cognitive decline following TAVI. Potential risk factors will be measured prior to TAVI. Primary outcomes will be post-procedure cognitive decline and delirium. Secondary outcomes include activities of daily living, quality of life, and mortality. Delirium presence will be measured on each of the first 2 days following TAVI. All other outcomes will be assessed at 3-, 6-, and 12-months post-operatively. A series of logistic regressions will be run to investigate the relationship between potential predictors and outcomes (presence vs. absence of either delirium or cognitive decline). Discussion: This study will assess the strengths of associations between a range of measures drawn from frailty and aging literature in terms of association with cognitive decline and delirium following TAVI. Identified measures can be used in future development of TAVI risk prediction models, which are essential for the accurate identification of cognitive at-risk patients and successful application of pre-procedural interventions. Clinical Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry. [https://bit.ly/2PAotP5], [ACTRN12618001114235].
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Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide University Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing Unit at UCL, London, United Kingdom
| | - Joseph Montarello
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jerrett K Lau
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sinny Delacroix
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Megan Keage
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, VIC, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
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7
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van der Wulp K, van Wely MH, Schoon Y, Vart P, Olde Rikkert MG, Morshuis WJ, van Royen N, Verkroost MW, Gehlmann HR, Van Garsse LA, Kievit PC. Geriatric assessment in the prediction of delirium and long-term survival after transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2021; 161:2095-2102.e3. [DOI: 10.1016/j.jtcvs.2020.02.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/07/2020] [Accepted: 02/14/2020] [Indexed: 12/15/2022]
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8
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Solla-Suárez P, Avanzas P, Pascual I, Bermúdez-Menéndez De La Granda M, Almendarez M, Arche-Coto JM, Hernández-Vaquero D, Lorca R, López-Álvarez E, Álvarez-Velasco R, Moreno-Planillo C, Morís de la Tassa C, Gutiérrez-Rodríguez J. Frailty Assessment in a Cohort of Elderly Patients with Severe Symptomatic Aortic Stenosis: Insights from the FRailty Evaluation in Severe Aortic Stenosis (FRESAS) Registry. J Clin Med 2021; 10:jcm10112345. [PMID: 34071871 PMCID: PMC8197816 DOI: 10.3390/jcm10112345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Precise evaluation of the degree of frailty is a fundamental part of the global geriatric assessment that helps to avoid therapies that could be futile. Our main objective was to determine the prevalence of frailty in a specific consult of patients undergoing aortic valve replacement. Methods: From May 2018 to February 2020, all consecutive patients ≥75 years old, with severe symptomatic aortic stenosis, undergoing valve replacement in the Principality of Asturias (Northern Spain) were evaluated. Results: A total of 286 patients were assessed. The mean age was 84 ± 4.01 years old; 175 (61.2%) were female. The short performance physical battery score was 8.5 ± 2.4 and the prevalence of frailty was 19.6% (56 patients). In the multivariable analysis, age, Barthel index and atrial fibrillation were independent predictors of frailty. Conclusions: The prevalence of frailty in our sample patients undergoing aortic valve replacement, evaluated by a standardized protocol, was 19.6%.
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Affiliation(s)
- Pablo Solla-Suárez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33011 Oviedo, Spain
| | - Isaac Pascual
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Biología Funcional, Universidad de Oviedo, 33011 Oviedo, Spain
- Correspondence:
| | - Manuel Bermúdez-Menéndez De La Granda
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Marcel Almendarez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Jose M. Arche-Coto
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Daniel Hernández-Vaquero
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Rebeca Lorca
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Eva López-Álvarez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Rut Álvarez-Velasco
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Carmen Moreno-Planillo
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
| | - César Morís de la Tassa
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33011 Oviedo, Spain
| | - José Gutiérrez-Rodríguez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
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9
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Saevik M, Beitnes JO, Aaberge L, Halvorsen PS. Safety and feasibility of dobutamine stress echocardiography in symptomatic high gradient aortic stenosis patients scheduled for transcatheter aortic valve implantation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:38-48. [PMID: 32914454 DOI: 10.1002/jcu.22915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/18/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We aimed to study the safety and feasibility of low-dose dobutamine stress echocardiography in a symptomatic high gradient aortic stenosis population scheduled for transfemoral transcatheter aortic valve implantation (TAVI) and to quantify left ventricular (LV) flow reserve. METHODS Fifty patients underwent dobutamine stress echocardiography with 5 minutes increments of 5 μg/kg/min up to 20 μg/kg/min until the heart rate increased ≥20 beats/min from baseline or exceeded 100 beats/min. Other criteria for discontinuing the infusion were major adverse events: ventricular arrhythmia, persistent supraventricular arrhythmia, pulmonary edema, chest pain with significant ST-changes, or minor events: ST-changes, drop in systolic blood pressure >30 mmHg, mild chest pain, and/or dyspnea. LV flow reserve was defined as an increase in stroke volume ≥20% during the test. RESULTS Of 50 patients, 45 completed the test according to protocol. No patient had major adverse event. Five patients experienced minor side effects: mild chest pain/dyspnea in three, self-terminating atrial flutter in one, and decrease in blood pressure in one. Significant LV flow reserve was observed in 20 patients (40%). CONCLUSION Low-dose dobutamine stress test appeared safe and feasible patients with high gradient aortic stenosis, and showed LV flow reserve in a minority of them.
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Affiliation(s)
- Marte Saevik
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan O Beitnes
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Per S Halvorsen
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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10
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Spaccarotella C, Migliarino S, Mongiardo A, Curcio A, de Rosa S, Corcione N, Quirino A, Barreca GS, Giancotti A, Peronace C, Marascio N, Matera G, Indolfi C. Fast-track ruling in/out SARS-CoV-2 infection with rapid 0/1.5 h molecular test in patients with acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2020; 21:975-979. [PMID: 33156158 DOI: 10.2459/jcm.0000000000001117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with acute coronary syndrome (ACS) often arrive in the catheterization (cath) lab directly from the field or an emergency department without an accurate triage for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Although in the pandemic period the treatment in the cath laboratory of high-risk ACS should not be delayed because the operators wear special protection systems, the subsequent risk of contagion in a non-Covid coronary care unit could be high in the case of patients positive for SARS-CoV-2. METHODS We tested the possibility of a fast-track protocol in 51 consecutive patients (mean age 65 ± 12 years) transferred from spokes centres or from the field to our HUB centre and admitted to our coronary care unit (CCU). Once the patient had arrived in the cath lab, the nasopharyngeal swab was performed. The real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated rapid molecular Xpert Xpress test. Meanwhile, coronary angiography or percutaneous coronary intervention was performed if necessary. RESULTS In this fast-track protocol, the time to perform nasopharyngeal swab was 11 ± 11 min; time spent to transport nasopharyngeal swab to the laboratory was 29 ± 20 min; time to detect viral nucleic acid was 68 ± 16 min. The overall time from the execution of nasopharyngeal swab to the result was 109 ± 26 min. The results were immediately put into the hospital computer system and made readily available. Depending on the test result, patients were then transferred to the regular CCU or Covid area. CONCLUSION This study demonstrates that 0-1.5 h fast-track triage for coronavirus disease 2019 (COVID 19) is feasible in patients with ACS. The execution of nasopharyngeal swab in the cath lab and its analysis with a rapid molecular test allows rapid stratification of SARS-CoV-2 infection.
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Affiliation(s)
- Carmen Spaccarotella
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro
| | | | | | - Antonio Curcio
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro
| | - Salvatore de Rosa
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro
| | - Nicola Corcione
- Division of Cardiology Clinica Pineta Mare, Castel Volturno, Neaples, Italy
| | - Angela Quirino
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Giorgio Settimo Barreca
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Aida Giancotti
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Cinzia Peronace
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Nadia Marascio
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Giovanni Matera
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Ciro Indolfi
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro.,Mediterranea Cardiocentro, Naples
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11
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Gutiérrez J, Avanzas P, Solla P, Díaz R, Solano JJ, Morís C. Valoración geriátrica integral de pacientes mayores con estenosis aórtica grave: utilidad en la detección de problemas y planificación de intervenciones. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Wleklik M, Uchmanowicz I, Jankowska EA, Vitale C, Lisiak M, Drozd M, Pobrotyn P, Tkaczyszyn M, Lee C. Multidimensional Approach to Frailty. Front Psychol 2020; 11:564. [PMID: 32273868 PMCID: PMC7115252 DOI: 10.3389/fpsyg.2020.00564] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/10/2020] [Indexed: 12/18/2022] Open
Abstract
The concept of frailty syndrome (FS) was first described in the scientific literature three decades ago. For a very long time, we understood it as a geriatric problem, recently becoming one of the dominant concepts in cardiology. It identifies symptoms of FS in one in 10 elderly people. It is estimated that in Europe, 17% of elderly people have FS. The changes in FS resemble and often overlap with changes associated with the physiological aging process of the body. Although there are numerous scientific reports confirming that FS is age correlated, it is not an unavoidable part of the aging process and does not apply only to the elderly. FS is a reversible clinical condition. To maximize benefits of frailty-reversing activities for patient with frailty, identification of its determinants appears to be fundamental. Many of the determinants of the FS have already been known: reduction in physical activity, malnutrition, sarcopenia, polypharmacy, depressive symptom, cognitive disorders, and lack of social support. This review shows that insight into FS determinants is the starting point for building both the comprehensive definition of FS and the adoption of the assessment method of FS, and then successful clinical management.
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Affiliation(s)
- Marta Wleklik
- Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | | | - Ewa A. Jankowska
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Cristiana Vitale
- Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Magdalena Lisiak
- Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Marcin Drozd
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | | | - Michał Tkaczyszyn
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Christopher Lee
- William F. Conell School of Nursing, Boston College, Newton, MA, United States
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13
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Piñón M, Paredes E, Acuña B, Raposeiras S, Casquero E, Ferrero A, Torres I, Legarra JJ, Pradas G, Barreiro-Morandeira F, Rodriguez-Pascual C. Frailty, disability and comorbidity: different domains lead to different effects after surgical aortic valve replacement in elderly patients. Interact Cardiovasc Thorac Surg 2020; 29:371-377. [PMID: 31220291 DOI: 10.1093/icvts/ivz093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/22/2019] [Accepted: 03/08/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Frailty syndrome predicts adverse outcomes after surgical aortic valve replacement. However, disability or comorbidity is frequently associated with preoperative frailty evaluation. The effects of these domains on early and late outcomes were analysed. METHODS A prospective study including patients aged ≥75 years with symptomatic severe aortic stenosis who received aortic valve replacement with or without coronary artery bypass grafting was conducted. We used the Cardiovascular Health Study Frailty Phenotype to assess frailty, the Lawton-Brody index to define disability and the Charlson comorbidity index (CCI) to evaluate comorbidity. RESULTS Frailty was identified in 57 (31%), dependence in 18 (9.9%) and advanced comorbidity (CCI ≥ 4) in 67 (36.6%) of the 183 enrolled patients. Operative mortality (1.6%), transfusion rate and duration of stay increased in patients with CCI ≥4 (P < 0.005). There was a non-significant trend for these adverse outcomes among the frail patients. Follow-up was achieved in all patients (median/interquartile range 869/699-1099 days). Kaplan-Meier univariable analysis showed a reduced survival rate for frail and dependent patients and for those with multiple comorbidities (P < 0.05). According to multivariable analysis, frailty and comorbidity were independent risk factors for 1-year mortality, while disability and comorbidity, but not frailty, were risk factors for 3-year mortality (P < 0.05). CONCLUSIONS Surgical aortic valve replacement in patients aged ≥75 years is a safe procedure with low mortality rates. Operative outcomes are mainly affected by comorbidities. The main influence of survival occurs throughout the first year, and an improved functional status prevents any progression towards disabilities, which could potentially benefit long-term outcomes. CLINICAL TRIAL REGISTRATION NUMBER NCT02745314.
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Affiliation(s)
- Miguel Piñón
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Emilio Paredes
- Department of Cardiology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Beatriz Acuña
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Sergio Raposeiras
- Department of Cardiology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Elena Casquero
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Ana Ferrero
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Ivett Torres
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Juan José Legarra
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Gonzalo Pradas
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Carlos Rodriguez-Pascual
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.,University of Lincoln, Lincoln, UK
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14
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Blumenstein J, Möllmann H, Bleiziffer S, Bauer T, Ensminger S, Bekeredjian R, Walther T, Frerker C, Beyersdorf F, Hamm C, Beckmann A. Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY). Clin Res Cardiol 2020; 109:1099-1106. [PMID: 31989251 DOI: 10.1007/s00392-020-01601-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcome of nonagenarians (≥ 90 years) with that of younger (< 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice. METHODS Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients. RESULTS Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p < 0.001), frail (38.7% vs. 34.7%, p < 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p < 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p > 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age ≥ 90 years could be identified as an isolated risk factor for mortality. CONCLUSION TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients-most probably due to the intrinsic higher risk profile of the very old patients-the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.
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Affiliation(s)
- J Blumenstein
- Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany
| | - H Möllmann
- Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany.
| | - S Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - T Bauer
- Department of Cardiology, Sana-Klinikum, Offenbach, Germany
| | - S Ensminger
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Lübeck, Germany
| | - R Bekeredjian
- Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany
| | - T Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Frankfurt, Germany
| | - C Frerker
- Department of Cardiology, University Hospital, Heart Center, Cologne, Germany
| | - F Beyersdorf
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Heart Center, Freiburg, Germany
| | - C Hamm
- Department of Medical Clinic I, University Hospital, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - A Beckmann
- Deutsche Gesellschaft für Thorax, Herz- Und Gefäßchirurgie, Berlin, Germany
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15
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Gutiérrez J, Avanzas P, Solla P, Díaz R, Solano JJ, Morís C. Comprehensive geriatric assessment in older patients with severe aortic stenosis: usefulness in detecting problems and planning interventions. ACTA ACUST UNITED AC 2020; 73:336-338. [PMID: 31932235 DOI: 10.1016/j.rec.2019.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- José Gutiérrez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain.
| | - Pablo Solla
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Rocío Díaz
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan José Solano
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - César Morís
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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16
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Francone M, Budde RPJ, Bremerich J, Dacher JN, Loewe C, Wolf F, Natale L, Pontone G, Redheuil A, Vliegenthart R, Nikolaou K, Gutberlet M, Salgado R. CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 2019; 30:2627-2650. [PMID: 31489471 PMCID: PMC7160220 DOI: 10.1007/s00330-019-06357-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/29/2019] [Accepted: 07/03/2019] [Indexed: 01/04/2023]
Abstract
Abstract Transcatheter aortic valve replacement (TAVR) is a minimally invasive alternative to conventional aortic valve replacement in symptomatic patients with severe aortic stenosis and contraindications to surgery. The procedure has shown to improve patient’s quality of life and prolong short- and mid-term survival in high-risk individuals, becoming a widely accepted therapeutic option which has been integrated into current clinical guidelines for the management of valvular heart disease. Nevertheless, not every patient at high-risk for surgery is a good candidate for TAVR. Besides clinical selection, which is usually established by the Heart Team, certain technical and anatomic criteria must be met as, unlike in surgical valve replacement, annular sizing is not performed under direct surgical evaluation but on the basis of non-invasive imaging findings. Present consensus document was outlined by a working group of researchers from the European Society of Cardiovascular Radiology (ESCR) and aims to provide guidance on the utilisation of CT and MR imaging prior to TAVR. Particular relevance is given to the technical requirements and standardisation of the scanning protocols which have to be tailored to the remarkable variability of the scanners currently utilised in clinical practice; recommendations regarding all required pre-procedural measurements and medical reporting standardisation have been also outlined, in order to ensure quality and consistency of reported data and terminology. Key Points • To provide a reference document for CT and MR acquisition techniques, taking into account the significant technological variation of available scanners. • To review all relevant measurements that are required and define a step-by-step guided approach for the measurements of different structures implicated in the procedure. • To propose a CT/MR reporting template to assist in consistent communication between various sites and specialists involved in the procedural planning. Electronic supplementary material The online version of this article (10.1007/s00330-019-06357-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Policlinico Umberto I, V.le Regina Elena 324, 00161, Rome, Italy.
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jens Bremerich
- Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Jean Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000, Rouen, France
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, Rome, Italy
| | | | - Alban Redheuil
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Department of Cardiovascular and Thoracic, Imaging and Interventional Radiology, Institute of Cardiology, APHP, Pitié-Salpêtrière University Hospital, Paris, France
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Paris, France
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kostantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tübingen, Germany
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, Holy Heart Hospital, Lier, Belgium
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17
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A cirurgia de substituição valvular aórtica melhora a qualidade de vida dos octogenários com estenose aórtica severa. Rev Port Cardiol 2019; 38:251-258. [DOI: 10.1016/j.repc.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/18/2018] [Accepted: 06/24/2018] [Indexed: 11/16/2022] Open
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18
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Bento D, Coelho P, Lopes J, Fragata J. Aortic valve replacement surgery improves the quality of life of octogenarians with severe aortic stenosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9849475. [PMID: 30302342 PMCID: PMC6158962 DOI: 10.1155/2018/9849475] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.
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Pires-Morais G, Gama V. The heart team approach to transcatheter aortic valve implantation: What has been done and what is to be expected. Rev Port Cardiol 2017; 36:819-821. [DOI: 10.1016/j.repc.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Pires-Morais G, Gama V. The heart team approach to transcatheter aortic valve implantation: What has been done and what is to be expected. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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