Periprocedural care for frail older patients with aortic stenosis undergoing transcatheter aortic valve replacement

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  Fig. 1. Approach to frail older individuals presenting with symptomatic severe aortic stenosis. In frail older individuals presenting with symptoms and found to have aortic stenosis (AS), consideration should be given to concurrent pathologies, which are often present with increasing age. These may be broadly divided into cardiac and extracardiac diseases and include atherosclerotic coronary artery disease, amyloidosis, arrhythmias, and lung diseases. Additional care aspects, including biological, social, and psychological issues, must also be considered in frail older individuals. These aspects of care should be addressed as part of the therapeutic care plan. Icons were made by Chanut-is-Industries at www.flaticon.com.

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  Fig. 2. Suggested care pathway for frail older individuals with aortic stenosis undergoing transcatheter aortic valve replacement. When frail older individuals present with symptoms of aortic stenosis, the severity of valve stenosis should be confirmed, and alternate diagnoses should be considered and excluded. In the preoperative phase, assessments should be made to determine the suitability of the intervention and the type of valve intervention. The decision should be made in discussion with the Heart team and the patient using a patient-centered iterative discussion. After a decision has been made for transcatheter valve replacement (TAVR), older frail individuals should be counseled and adequately optimized to improve their physiological reserves as much as possible. Perioperatively, additional effort should be made to minimize complications and improve postoperative recovery. Early recovery and delirium prevention protocols help facilitate recovery and early discharge in the postoperative phase. Post-discharge, there should be continued care in the community, cardiac rehabilitation, and close follow-up with the cardiologist for valve surveillance. AS = aortic stenosis; ERAS = Early…