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
Review
. 2024 Jul 16;13(14):4169.
doi: 10.3390/jcm13144169.

A Comprehensive Geriatric Workup and Frailty Assessment in Older Patients with Severe Aortic Stenosis

Enrico Brunetti  1   2 , Fabiana Lucà  3 , Roberto Presta  1 , Niccolò Marchionni  2 , Alessandro Boccanelli  4 , Andrea Ungar  2 , Carmelo Massimiliano Rao  3 , Nadia Ingianni  5 , Maddalena Lettino  6 , Donatella Del Sindaco  7 , Adriano Murrone  8 , Carmine Riccio  9 , Furio Colivicchi  10 , Massimo Grimaldi  11 , Michele Massimo Gulizia  12 , Fabrizio Oliva  13 , Mario Bo  1 , Iris Parrini  14 ; Italian Society of Geriatric Cardiology (SICGe), Cardiogeriatrics Working Group of Italian Association of Hospital Cardiologists, (ANMCO), Multi-Specialist and Multi-Integrated Approach in Cardiac Patients Working Group ANMCO
Affiliations
Review

A Comprehensive Geriatric Workup and Frailty Assessment in Older Patients with Severe Aortic Stenosis

Enrico Brunetti et al. J Clin Med. .

Abstract

Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients' stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being.

Keywords: elderly; frailty; side adverse; transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The Clinical Frailty Scale (CFS) is used to assess the degree of frailty in older adults. Frailty is a multidimensional syndrome characterized by a poor physiologic condition and increased vulnerability.
Figure 2
Figure 2
Factors of TAVR non-response. Abbreviation: CLD: chronic lung disease; CKD: chronic kidney disease; MR: mitral regurgitation; LVEF: left ventricle. Ejection fraction.
Figure 3
Figure 3
Clinical pathway of geriatric assessment in older patients with severe aortic stenosis.
Figure 4
Figure 4
Cardiac rehabilitation (CR) after transcatheter aortic valve replacement (TAVR).
See this image and copyright information in PMC

References

    1. Owens D.S., Bartz T.M., Buzkova P., Massera D., Biggs M.L., Carlson S.D., Psaty B.M., Sotoodehnia N., Gottdiener J.S., Kizer J.R. Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults. Heart. 2021;107:1493–1502. doi: 10.1136/heartjnl-2021-319025. - DOI - PMC - PubMed
    1. Stewart S., Chan Y.K., Playford D., Strange G.A. Incident aortic stenosis in 49,449 men and 42,229 women investigated with routine echocardiography. Heart. 2022;108:875–881. doi: 10.1136/heartjnl-2021-319697. - DOI - PubMed
    1. Kolkailah A.A., Doukky R., Pelletier M.P., Volgman A.S., Kaneko T., Nabhan A.F. Cochrane corner: Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk. Heart. 2020;106:1043–1045. doi: 10.1136/heartjnl-2020-316661. - DOI - PubMed
    1. Leon M.B., Smith C.R., Mack M.J., Makkar R.R., Svensson L.G., Kodali S.K., Thourani V.H., Tuzcu E.M., Miller D.C., Herrmann H.C., et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N. Engl. J. Med. 2016;374:1609–1620. doi: 10.1056/NEJMoa1514616. - DOI - PubMed
    1. Leon M.B., Smith C.R., Mack M., Miller D.C., Moses J.W., Svensson L.G., Tuzcu E.M., Webb J.G., Fontana G.P., Makkar R.R., et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010;363:1597–1607. doi: 10.1056/NEJMoa1008232. - DOI - PubMed

LinkOut - more resources