MONDAY, Feb. 11, 2019 — Older patients with severe frailty undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) frequently experience subsequent functional decline or lack of improvement, according to a study published online Feb. 4 in JAMA Internal Medicine.
Dae Hyun Kim, M.D., M.P.H., Sc.D., from Harvard Medical School in Boston, and colleagues conducted a prospective cohort study with a 12-month follow-up in 246 patients (mean age, 84.2 years) undergoing TAVR or SAVR for severe aortic stenosis. Participants underwent a preoperative comprehensive geriatric assessment, and a deficit-accumulation frailty index (CGA-FI) was calculated. Self-reported ability to perform 22 activities and physical tasks was assessed at one, three, six, nine, and 12 months after the procedure.
The researchers identified five trajectories based on functional status at baseline and during follow-up. There was a correlation for preoperative frailty level with a lower probability of functional improvement and a greater probability of functional decline. After TAVR, patients with a CGA-FI level of 0.51 or greater had poor or very poor trajectories (45.5 and 22.7 percent, respectively). After SAVR, a fair trajectory was seen in 71.4 percent of those with CGA-FI levels of 0.41 to 0.5. There was a correlation for postoperative delirium and major complications with functional decline after TAVR or lack of improvement after SAVR.
“Our study offers insight into the role of frailty assessment in predicting heterogeneous functional trajectories,” the authors write. “Anticipated functional trajectories after the procedure should inform patient-centered shared decision making about these procedures and perioperative care to optimize functional outcomes.”
Two authors disclosed financial ties to the medical device industries.
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Posted: February 2019