Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Apr 1;3(2):123-132.
doi: 10.1093/ehjqcco/qcw030.

The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis

Atul Anand  1 , Catherine Harley  2 , Akila Visvanathan  2 , Anoop S V Shah  1 , Joanna Cowell  2 , Alasdair MacLullich  3 , Susan Shenkin  3 , Nicholas L Mills  1
Affiliations
Meta-Analysis

The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis

Atul Anand et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: Transcatheter aortic valve implantation (TAVI) is an increasingly common intervention for patients with aortic stenosis deemed high risk for major cardiac surgery, but identifying those who will benefit can be challenging. Frailty reflects physiological reserve and may be a useful prognostic marker in this population. We performed a systematic review and meta-analysis of the association between frailty and outcomes after TAVI.

Methods and results: Five databases were searched between January 2000 and May 2015. From 2623 articles screened, 54 were assessed for eligibility. Ten cohort studies (n = 4592) met the inclusion criteria of reporting a measure of frailty with early (≤30 days) or late (>30 days) mortality and procedural complications following TAVI as defined by the Valve Academic Research Consortium (VARC). Frailty was associated with increased early mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P < 0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63, 95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P < 0.001). Frail individuals undergoing TAVI have a mortality rate of 34 deaths per 100 patient years, compared with 19 deaths per 100 patient years in non-frail patients. There was limited reporting of VARC procedural outcomes in relation to frailty, preventing meta-analysis.

Conclusion: Frailty assessment in an already vulnerable TAVI population identifies individuals at even greater risk of poor outcomes. Use of objective frailty tools may inform patient selection, but this requires further assessment in large prospective registries.

Keywords: Ageing; Aortic stenosis; Frailty; Prognosis; Risk factors; TAVI.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of reviewed studies.
Figure 2
Figure 2
Risk of early (≤30 days after TAVI) and late (>30 days) mortality in studies suitable for meta-analysis ordered by date of publication. Summary meta-estimate calculations based on random-effects model analysis.
Figure 3
Figure 3
Risk of late (>30 days after TAVI) mortality amongst frail patients. Summary meta-estimates presented grouped by type of frailty assessment used (subjective vs. objective), adjustment for confounders (unadjusted vs. adjusted) and study quality with regard to frailty reporting (high vs. low). All summary meta-estimate calculations based on random-effects model analysis. Individual study level data are presented in Supplementary material online, Figure S1.
See this image and copyright information in PMC

References

    1. Osnabrugge RLJ, Mylotte D, Head SJ, Mieghem NMV, Nkomo VT, LeReun CM, Bogers JJC, Piazza N, Kappetein AP. Aortic stenosis in the elderly. J Am Coll Cardiol 2013;62:1002–1012. - PubMed
    1. Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F. Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. Am Heart J 2012;164:410–418. - PubMed
    1. O'Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand ST, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, Anderson RP. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg 2009;88:S23–S42. - PubMed
    1. Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16:9–13. - PubMed
    1. Rosenhek R, Iung B, Tornos P, Antunes MJ, Prendergast BD, Otto CM, Kappetein AP, Stepinska J, Kaden JJ, Naber CK, Acarturk E, Gohlke-Barwolf C. ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J 2012;33:822–828. - PMC - PubMed

Publication types