Transcatheter (n=1,598) and surgical (n=200) aortic valve replacement did not lead to overall significant changes in frailty measurements, though improvements were seen in lower-risk TAVI cohorts.
Meta-Analysis (n=1,798)
Does transcatheter or surgical aortic valve replacement improve frailty in patients with aortic stenosis?
Aortic valve replacement (TAVI or SAVR) does not lead to significant overall changes in frailty, except potentially in lower-risk TAVI patients.
BACKGROUND: Frailty is common among patients awaiting intervention for aortic stenosis (AS) by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Although the association between pre-procedure frailty and poor outcomes is well-established, it remains unclear whether aortic valve interventions can lead to changes in frailty. METHODS: Ovid MEDLINE, SCOPUS, CINAHL and Cochrane databases were searched for studies that reported frailty assessments before and after TAVI and/or SAVR. Data from these studies were used to calculate a standardised score for change in frailty following either TAVI or SAVR, as part of a pooled random effects meta-analysis, with Hedges' adjusted g value. RESULTS: Of 4,093 records screened, nine relevant studies were identified. Among 1,598 TAVI and 200 SAVR patients, no overall changes to frailty were observed, although there was considerable heterogeneity among studies. Improvements to frailty were observed in a sensitivity analysis of lower-risk TAVI cohorts (Society of Thoracic Surgeons predicted risk of mortality STS-PROM ≤5%). Higher-risk TAVI and SAVR cohorts (STS-PROM >5%) did not show improvements in frailty post-aortic valve intervention. CONCLUSIONS: Overall, neither TAVI nor SAVR leads to significant changes in frailty measurements, although data are highly heterogeneous. Further research into the possible role of additional frailty interventions, particularly in higher-risk patients with AS undergoing TAVI or SAVR, should be considered.
Mohiaddin et al. (Fri,) conducted a meta-analysis in Aortic stenosis (n=1,798). Transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) was evaluated on Change in frailty following TAVI or SAVR. Transcatheter (n=1,598) and surgical (n=200) aortic valve replacement did not lead to overall significant changes in frailty measurements, though improvements were seen in lower-risk TAVI cohorts.