Article Sidebar
Views pdf: 62
IMPACT OF FRAILTY ON CLINICAL OUTCOMES IN ELDERLY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
Main Article Content
Abstract
Background: Transcatheter aortic valve replacement is a safer alternative to valve replacement surgery and has become a popular treatment in aortic stenosis. Elderly patients with frailty who receive transcatheter aortic valve replacement may not change prognosis, even have worse outcomes and higher mortality than non-frail patients. Objective: Identify the impact of frailty on clinical outcomes in elderly patients after transcatheter aortic valve replacement at Vinmec Central Park Hospital. Methods: The study was conducted from January 2017 to May 2022, in elderly patients with symptomatic aortic stenosis undergoing transcatheter aortic valve replacement. Assessment of frailty using the following indices: albumin level, anemia and Katz index of independence in Activities of Daily Living. The composite clinical endpoint included all outcomes occurring 1 month, 6 months, and 12 months after transcatheter aortic valve replacement. Testing the relationship between frailty and overall clinical outcome by logistic regression, the difference was statistically significant with p<0.05. Results: The study enrolled 73 elderly patients, with a median age of 69 (62–76). Composite clinical outcome (procedure failure, vascular complications, major bleeding, stroke, acute kidney injury, pacemaker placement and mortality) at 1 month, 6 months, and 12 months, respectively, accounted for 34.25%, 36.99% and 38.36%. Patients with 3 abnormal frailty indices had an increased ability of adverse clinical outcomes at 1 month, 6 months, and 12 months (p = 0.030, p = 0.036 and p = 0.024, respectively). Conclusions: Preliminary findings suggest that elderly patients with impairment in activities of daily living, low albumin levels, and anemia are associated with an increased ability of 1-month, 6-month, and 12-month clinical outcomes after transcatheter aortic valve replacement
Article Details
Keywords
transcatheter aortic valve replacement, frailty, elderly, outcome.
References
1. Iung Bernard, Vahanian A. Epidemiology of valvular heart disease in the adult. 2011;8(3):pp. 162.
2. Roberta A, Salvatore C P. Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world? e-Journal of Cardiology Practice. 2020;18(10).
3. Pellikka P A, Sarano M E, Nishimura R A, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. Jun 21 2005;111(24):pp. 3290-5.
4. Ross J Jr, Braunwald E. Aortic stenosis. Circulation. Jul 1968;38(1 Suppl):pp. 61-7.
5. Horstkotte D, Loogen F. The natural history of aortic valve stenosis. European Heart Journal. 1988;9(suppl_E):pp. 57-64.
6. Nishimura R A, Otto C M, Bonow R O, et al. 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 Practice Guidelines. Circulation. Jun 10 2014;129(23):pp. e521-643.
7. Smith C R, Leon M B, Mack M J, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. The New England journal of medicine. Jun 9 2011;364(23):pp. 2187-98.
8. Leon M B, Smith C R, Mack M J, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. The New England journal of medicine. Apr 28 2016;374(17):pp. 1609-20.
9. Reardon M J, Van Mieghem N M, Popma J J, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. The New England journal of medicine. Apr 6 2017;376(14):pp. 1321-1331.
10. Baron S J, Arnold S V, Wang K, et al. Health status benefits of transcatheter vs surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk: results from the PARTNER 2 randomized clinical trial. 2017;2(8):pp. 837-845.