Key result
TAVI links to ~2-fold higher 1-year mortality versus SAVR, driven by higher baseline patient risk.
Why the study?
There is no gold-standard method for assessing frailty, and existing scores lack prospective data and record only limited aspects of frailty.
Does transcatheter aortic valve implantation yield comparable clinical outcomes to surgical aortic valve replacement in elderly patients with severe aortic stenosis and differing frailty profiles?
Cohort (n=306)
No
Does transcatheter aortic valve implantation yield comparable clinical outcomes to surgical aortic valve replacement in elderly patients with severe aortic stenosis and differing frailty profiles?
TAVI provides substantial symptomatic and hemodynamic improvement for frail, elderly patients with severe aortic stenosis, with long-term survival primarily dictated by underlying comorbidities rather than the chosen intervention.
Answers are grounded in this paper and cite their sources.
Supports TAVI for symptomatic relief in frail elderly AS patients; leaves open whether mortality gaps reflect selection or intervention effects.
(1) Background: The aging process leads to an increased number of patients with cardiovascular diseases that require surgical treatment. One of the most common heart diseases with an increased prevalence in the elderly is aortic stenosis (AS). Recently, transcatheter aortic valve implantation (TAVI) has become the preferred technique for frail patients with high surgical risk. Currently, there is no gold standard method for assessing frailty. The available scores are objective, but limited by the lack of prospective information, especially from patients undergoing cardiac surgery or interventional procedures. Moreover, the current frailty scores record only certain aspects of the frailty identified in some system and organs. The aims of this study were to evaluate the different profile patients treated with TAVI or with surgical aortic valve replacement (SAVR) and to analyze the risk factors of unfavorable outcomes in the two groups to identify potential factors for frailty that could be included in the new scoring system. (2) Methods: This study included patients over 65 years old evaluated with severe, symptomatic AS treated with TAVI or SAVR admitted to the Cardiovascular Diseases Institute, Iasi. (3) Results: The group included 88 patients treated with TAVI compared with 218 patients undergoing SAVR. Most of the TAVI patients (84.09%) were over 70 years compared to 30.09% of the SAVR group. The TAVI patients had an increased surgical risk assessed by EuroSCORE II (15 vs. 4%) and severe heart failure (NYHA IV, 36.36 vs. 6.48%). The only residual symptom was dyspnea, in a significantly lower prevalence compared to preoperative evaluation. (4) Conclusions: TAVI improves the general status with results comparable to SAVR in elderly patients with increased severity of the disease and higher prevalence of comorbidities.
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Oancea et al. (2021) conducted a cohort in Severe, symptomatic aortic stenosis (n=306). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on 1-year cumulative mortality. Transcatheter aortic valve implantation improved patient symptoms and hemodynamics with results comparable to surgery, though 1-year cumulative mortality was higher due to severe baseline frailty and comorbidities.
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