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Review
. 2020 May;28(5):280-292.
doi: 10.1007/s12471-020-01379-0.

Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

M S van Mourik  1 , J F Velu  1 , V R Lanting  1 , J Limpens  2 , B J Bouma  1 , J J Piek  1 , J Baan  1 , J P S Henriques  1 , M M Vis  3
Affiliations
Review

Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

M S van Mourik et al. Neth Heart J. 2020 May.

Abstract

Guidelines suggest using frailty characteristics in the work-up for a transcatheter aortic valve implantation (TAVI). There are many frailty-screening tools with different components. The prognostic value of the individual parameters in frailty is as yet unclear. The objective of this systematic review and meta-analysis was to find and pool predictors for 1‑year mortality after TAVI. We followed a two-step approach. First, we searched for randomised controlled trials on TAVI to identify frailty parameters used in these studies. Second, we searched for publications on these frailty parameters. Articles were included for pooled analysis if the studied frailty parameters were dichotomised with clear cut-off values based on common standards or clinical practice and reported adjusted hazard ratios (HR) of 1‑year mortality after TAVI. We calculated pooled effect estimates of 49 studies based on dichotomised frailty scores (HR: 2.16, 95% CI: 1.57-3.00), chronic lung disease (HR: 1.57, 95% CI: 1.45-1.70), estimated glomerular filtration rate <30 ml/min (HR: 1.95, 95% CI: 1.68-2.29), body mass index <20 kg/m2 (HR: 1.49, 95% CI: 1.09-2.03), hypoalbuminaemia (HR: 1.77, 95% CI: 1.38-2.25), anaemia (HR: 2.08, 95% CI: 0.93-4.66), low gait speed (HR: 13.33, 95% CI: 1.75-101.49) and Katz activities of daily living (ADL) score of 1 or more deficits (HR: 5.16, 95% CI: 0.77-34.47). Chronic lung disease, chronic kidney disease, underweight, hypoalbuminaemia, a low frailty score, anaemia, low gait speed and an ADL deficiency were associated with worse 1‑year outcomes after TAVI.

Keywords: Frailty; Mortality; Outcome; Predictor; Transcatheter aortic valve implantation.

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Conflict of interest statement

M.S. van Mourik, J.F. Velu, V.R. Lanting, J. Limpens, B.J. Bouma, J.J. Piek, J. Baan, J.P.S. Henriques and M.M. Vis declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart. TAVI transcatheter aortic valve implantation, HR hazard ratio
Fig. 2
Fig. 2
a–h Forest plot per variable (multivariate HR for 1‑year mortality after transcatheter aortic valve implantation). a Chronic lung disease. b Estimated glomerular filtration rate <30 ml/min. c Body mass index <20. d Hypoalbuminaemia. e Low frailty score. f Anaemia. g Low gait speed. h Deficiency in activities of daily life. HR hazard ratio, TE treatment effect, seTE standard error treatment effect
Fig. 3
Fig. 3
Forest plot summarising all variables. eGFR estimated glomerular filtration rate, BMI body mass index, ADL activities of daily living
See this image and copyright information in PMC

References

    1. Otto CM, Kumbhani DJ, Alexander KP, Calhoon JH, Desai MY, Kaul S, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol. 2017;69(10):1313–1346. - PubMed
    1. Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–2791. doi: 10.1093/eurheartj/ehx391. - DOI - PubMed
    1. Halkin A, Steinvil A, Witberg G, Barsheshet A, Barkagan M, Assali A, et al. Mortality prediction following transcatheter aortic valve replacement: a quantitative comparison of risk scores derived from populations treated with either surgical or percutaneous aortic valve replacement. The Israeli TAVR registry risk model accuracy assessment (IRRMA) study. Int J Cardiol. 2016;215:227–231. - PubMed
    1. Ludman PF, Moat N, de Belder MA, Blackman DJ, Duncan A, Banya W, et al. Transcatheter aortic valve implantation in the united kingdom: temporal trends, predictors of outcome, and 6-year follow-up: a report from the UK Transcatheter aortic valve implantation (TAVI) registry, 2007 to 2012. Circulation. 2015;131(13):1181–1190. - PubMed
    1. Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document. J Am Coll Cardiol. 2012;60(15):1438–1454. - PubMed

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