Key result
Transcatheter aortic valve implantation was associated with significantly lower 1-year all-cause mortality compared to no TAVI (16% vs 46%) in presumably frail patients with severe aortic stenosis.
Why the study?
Some patients with severe aortic stenosis are denied surgical or TAVI therapy due to frailty, and it was unknown whether a comprehensive geriatric assessment could predict prognosis in this population.
Does TAVI improve 1-year mortality compared to medical therapy in presumably frail patients with symptomatic severe aortic stenosis, and what is the prognostic value of a comprehensive geriatric assessment?
Cohort (n=161)
No
Does TAVI improve 1-year mortality compared to medical therapy in presumably frail patients with symptomatic severe aortic stenosis, and what is the prognostic value of a comprehensive geriatric assessment?
Hazard Ratio: 76.92 (95% CI 3.47–1707)
Absolute Event Rate: 16% vs 46%
Absolute Risk Reduction: 30%
p-value: p=0.006
In presumably frail patients with severe aortic stenosis denied surgery, TAVI was associated with reduced 1-year mortality, and the Five-Times-Sit-to-Stand-Test was a strong independent predictor of mortality in those managed medically.
May support TAVI evaluation in frail severe AS; hypothesis-generating and requires randomized confirmation before practice change.
Introduction Despite of suffering a severe aortic stenosis, some patients are denied from either surgical or Transcatheter Aortic Valve Implantation (TAVI) therapy because of a frail condition. We aim to identify whether a comprehensive geriatric assessment (CGA) might be useful to predict prognosis of presumably frail patients with severe aortic stenosis. Material and methods Between March 2011 and July 2016, 818 patients were consecutively and prospectively enrolled. 161 had a CGA and were considered for analysis. Considering combined CGA and Heart team recommendations, 102 TAVI were performed (TAVI group) and 59 patients constituted the no TAVI group. Primary endpoint was all-cause mortality at one year. Results There was no difference between the TAVI and the no TAVI groups considering morphometric data, cardiovascular risk factors or symptoms. The no TAVI group had higher surgical risk (logistic EuroSCORE1 33.4±17.8 vs. 22.7±14.9; p<0.001) and more moderate renal insufficiency (82% vs. 57%; p=0.001). One-year mortality was 16% in the TAVI group and 46% in the no TAVI group (p<0.001). Multivariate analysis revealed history of pulmonary edema, moderate renal failure, and not having a TAVI, to relate to 1-year mortality. There was an interaction of the Five-Times-Sit-to-Stand-Test (FTSST) upon the effect of TAVI on mortality (p=0.049), as FTSST was the only predictor for 1-year mortality in the no TAVI group (HR:0.18 95%CI 0.04–0.76; p=0.019). Conclusions One-year mortality was higher in geriatric-assessed frail patient who did not undergo TAVI. FTSST, which assesses patients’ mobility, was the only prognostic marker for 1-year mortality, on top of usual medical parameters.
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Camarzana et al. (2021) conducted a cohort in Symptomatic severe aortic stenosis in presumably frail patients (n=161). Transcatheter aortic valve implantation (TAVI) vs. No TAVI (medical management) was evaluated on All-cause mortality at 1 year (HR 76.92, 95% CI 3.47-1707, p=0.006). Transcatheter aortic valve implantation was associated with significantly lower 1-year all-cause mortality compared to no TAVI (16% vs 46%) in presumably frail patients with severe aortic stenosis.
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