Transcatheter Aortic Valve Implantation in Elderly Patients With Aortic Valve Stenosis: The Role of Frailty, Malnutrition, and Sarcopenia

alnutrition is one of the hallmarks of frailty in elderly patients and a predictor of worse outcomes in elderly patients with severe aortic valve stenosis. 1 In this context, Ishizu et al 2 present in this issue of the Journal of the American Heart Association (JAHA) their analyses on prevalence and prognostic value of the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index for malnutrition assessment of Japanese elderly patients at high surgical risk undergoing transcatheter aortic valve implantation (TAVI). They found that malnourishment in their population was common and associated with increased mortality after TAVI regardless of the nutrition index used and irrespective of age, sex, body mass index, frailty, kidney function, and left ventricular ejection fraction. This phenomenon had already been observed by the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-TAVI) investigators, 3 who found nutritional status as a surrogate marker for predicting worse clinical outcomes after TAVI. While one may argue that this finding might apply only to this select population (only Japanese and very old patients with a mean age >80 years) with a well-defined risk profile (only at high risk), the current evidence shows that patients with different risk profiles (not only those at high risk) and other Asian and Western populations are under the negative impact of malnutrition as well.