Impact of a mobile geriatric team assessment on decision-making and outcomes in older patients evaluated for TAVI

Transcatheter aortic valve implantation (TAVI) is the main interventional option for elderly patients with severe aortic stenosis who are at high surgical risk. However, the role of systematic geriatric assessment in the pre-TAVI work-up remains insufficiently defined. The objective of this study was to identify factors associated with mortality and rehospitalization at one year by analysing the characteristics of a cohort of patients evaluated by a mobile geriatric team (MGT). This was a single-center retrospective study including patients aged ≥ 65 years who were assessed by the MGT as part of a pre-TAVI assessment between January 2018 and December 2022. Data collected included functional status (ADL, mini-IADL), cognition (MMSE), multimorbidity (≥ 5 comorbidities), polypharmacy (> 5 medications), and whether or not TAVI was performed. One hundred and thirty-two patients were included (mean age 85.2 ± 4.9 years). 52% underwent TAVI. Patients who underwent TAVI had better functional status (significantly higher ADL and mini-IADL scores), higher MMSE scores, and fewer comorbid conditions. Both mortality and rehospitalization at one year were significantly more frequent in patients who did not undergo TAVI. In 17% of cases, the final decision regarding TAVI differed from the MGT recommendation regarding suitability for the procedure. This discordance was not associated with one-year mortality. Structured geriatric assessment helps identify the frailest patients and optimize the selection of candidates for TAVI. Functional independence and comorbidity burden appear to be major determinants of outcome at one year.