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. 2023 May 13;10(5):212.
doi: 10.3390/jcdd10050212.

The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement

Annamaria Mazzone  1 , Serena Del Turco  2 , Giuseppe Trianni  1 , Paola Quadrelli  3 , Marco Marotta  3 , Luca Bastiani  2 , Tommaso Gasbarri  3 , Andreina D'Agostino  1 , Massimiliano Mariani  1 , Giuseppina Basta  2 , Ilenia Foffa  4 , Silverio Sbrana  4 , Cristina Vassalle  5 , Marcello Ravani  1 , Marco Solinas  3 , Sergio Berti  1
Affiliations

The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement

Annamaria Mazzone et al. J Cardiovasc Dev Dis. .

Abstract

Background: Frailty is highly common in older patients (pts) undergoing transcatheter aortic valve replacement (TAVR), and it is associated with poor outcomes. The selection of patients who can benefit from this procedure is necessary and challenging. The aim of the present study is to evaluate outcomes in older severe aortic valve stenosis (AS) pts, selected by a multidisciplinary approach for surgical, clinical, and geriatric risk and referred to treatment, according to frailty levels. Methods: A total of 109 pts (83 ± 5 years; females, 68%) with AS were classified by Fried's score in pre-frail, early frail, and frail and underwent surgical aortic valve replacement SAVR/TAVR, balloon aortic valvuloplasty, or medical therapy. We evaluated geriatric, clinical, and surgical features and detected periprocedural complications. The outcome was all-cause mortality. Results: Increasing frailty was associated with the worst clinical, surgical, geriatric conditions. By using Kaplan-Meier analysis, the survival rate was higher in pre-frail and TAVR groups (p < 0.001) (median follow-up = 20 months). By using the Cox regression model, frailty (p = 0.004), heart failure (p = 0.007), EF% (p = 0.043), albumin (p = 0.018) were associated with all-cause mortality. Conclusions: According to tailored frailty management, elderly AS pts with early frailty levels seem to be the most suitable candidates for TAVR/SAVR for positive outcomes because advanced frailty would make each treatment futile or palliative.

Keywords: aortic stenosis; frailty; mortality; pre-frailty; transcatheter aortic valve replacement.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of all-cause mortality and CV death according to frailty status at 20 months. CV: cardiovascular.
Figure 2
Figure 2
Kaplan–Meier survival curves. The survival rate at 20 months was higher in pre-frail patients ((A), long rank < 0.0001) and in the patients who underwent TAVR treatment ((B), long rank < 0.0001). Numbers of patients for frail group are shown at each time. Abbreviations as in Table 1.
Figure 3
Figure 3
Cox proportional hazard regression analysis of risk of all-cause mortality in elderly AS patients. Frailty, CHF, albumin, and EF were associated with increased risk of all-cause death in a multivariate model adjusted for sex and age. HR: hazard ratio. Other abbreviations as in Table 1.
See this image and copyright information in PMC

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