Geriatric assessment and results of transcatheter aortic valve implantation

Abstract

Introduction: Comprehensive geriatric assessment (CGA) prior to transcatheter aortic valve replacement implantation (TAVI) for severe aortic stenosis (AS) may improve the selection of patients targeted for this strategy. Despite the fact that CGA includes multiple scales, comparative data among them are limited. Our aim was to evaluate the discriminative capacity of different scales used in CGA on the decision of suitability for TAVI implantation and the influence on prognosis after TAVI implantation.

Methods: Single-center prospective observational study including consecutive patients with severe AS referred for TAVI implantation. A CGA was performed in all patients including scales of functionality, frailty, cognitive impairment and comorbidities. The predictive capacity of each of the scales was evaluated. The development of major adverse cardiovascular events (MACE: cardiovascular mortality, heart failure [HF] and stroke) was analyzed during follow-up.

Results: A total of 142 patients were selected as candidates for TAVI (80.2%), and 121 were finally implanted. The mean age was 83±4.9 years. Patients who were candidates for TAVI had less valvular area, less atrial fibrillation (AF), less cognitive impairment, more autonomy and less frailty. The SPPB frailty and Barthel functional assessment scales were the main scales of the CGA for the TAVI candidacy decision. After TAVI implantation, 21.5% presented a MACE event, with an overall mortality of 19.8% (6.6% cardiovascular). Patients with a higher rate of events and mortality had more AF, HF, renal disease and malnutrition, as well as less family coverage.

Conclusions: In elderly patients with severe AS, the CGA is a determining factor in the selection of candidates for TAVI, with frailty and functional assessment being the most important aspects. Family support and nutritional status have a high impact on the prognosis of patients after TAVI.

Keywords: Aortic stenosis; Cardio-geriatrics; Cardiogeriatría; Comprehensive geriatric assessment; Estenosis aórtica; Fragilidad; Frailty; Implante transcatéter de prótesis aórtica; Transcatheter aortic valve implantation; Valoración geriátrica integral.