Author + information
- S1936879815022438-22ca6bb575feb9b0401e73b8ef13bd3aSarkis Kiramijyan,
- S1936879815022438-0e824b6bd196b6c074117d96f588e1f3Edward Koifman,
- S1936879815022438-2ef4fd46aef321832fdb1c7864957db8Nirav S. Patel,
- S1936879815022438-04922536d0743a257a0e4850a20bd531Romain Didier,
- S1936879815022438-c28ef8324609c4b84e6e56464f67a80bJoelle S. Salmon,
- S1936879815022438-ac6baee9b2d67e86580300298fd59b00Arpi Tavil-Shatelyan,
- S1936879815022438-f1beaa2a0a3caab21a380eec0a5fb88bMarco A. Magalhaes,
- S1936879815022438-bbfc27c4c24676b0f667340848b2fe54Ricardo O. Escarcega,
- S1936879815022438-bc716c41fbc735dfd7fb756e5fbc605aNevin C. Baker,
- S1936879815022438-f2fba11771803d19febae944f1783e96Smita I. Negi,
- S1936879815022438-bb7d56defc47dfa50850f194a4d010d0Toby Rogers,
- S1936879815022438-b41fe52590ef8bb393cebb8b291037bfArie Steinvil,
- S1936879815022438-5b7636d8d04484081f5f4924f987cae2Michael J. Lipinski,
- S1936879815022438-a6c1bc52851ff7a2f92d51d27345d37fSang Yeub Lee,
- S1936879815022438-931563e2cf56fef96b8356fb1cdb589cJiaxiang Gai,
- S1936879815022438-43188b297454714a1e633ce32956ff39Rebecca Torguson,
- S1936879815022438-bc417308326f0e29f4cc19e35b7b7822Petros Okubagzi,
- S1936879815022438-bbfe4b1a6caf8afb1be83f37a64f1642Michael A. Gaglia Jr,
- S1936879815022438-280150bfca3f0be2b424079de79e87c6Itsik Ben-Dor,
- S1936879815022438-1beb110080eda2e5633fee03af8a17f9Christian C. Shults,
- S1936879815022438-15e037953a577bc0c95a638e38a8b37dPaul J. Corso,
- S1936879815022438-1afcf597a9ea0e6a884d08efd238ef1fLowell F. Satler,
- S1936879815022438-6a643b5155cb73800c3dcdf29c00727cAugusto D. Pichard and
- S1936879815022438-772b1cb1fca98a9f26e1e7f8bddc725bRon Waksman
Frailty assessment and its impact in transcatheter aortic valve replacement (TAVR) patients remain unclear. The aim of this study was to evaluate the long-term impact of frailty and assess for specific predictors of mortality.
All patients who underwent TAVR from May 2007 through May 2015 were retrospectively analyzed. Only patients with objective frailty data were included. The cohort was divided into two groups: frail vs. non-frail, based on the combined baseline frailty assessment. Frailty was specifically defined as failure of at least 3 of the 5 conventional, pre-specified indices of frailty: body mass index (BMI) (<20 kg/m2), Katz activities of daily living ≤4/6, serum albumin (<3.5 g/dL), grip strength (algorithm based on sex, BMI, and grip in kilograms), and 5 meter walking time (algorithm based on sex, height and walk time in seconds).
A total of 191 consecutive patients (51% male, mean age 81 years) were assessed as frail (n=89) or non-frail (n=102). The frail patients were older, and had higher rates of lung disease, atrial fibrillation, heart failure, and STS scores. The in-hospital and 30-days mortality rates were similar between the two groups, however there was a trend toward higher mortality in the frail group at 1-year (Kaplan-Meier, long-rank p=0.081) (Figure). A comprehensive univariate Cox regression model demonstrated that among the 5 indices assessed, only low BMI (<20 kg/m2) demonstrated a trend toward being a significant predictor of 1-year mortality (HR=2.19, p=0.082, 95% CI=0.91-5.31).
Frailty, as assessed by a combination of indices, likely portends an increased risk of mortality in TAVR patients, and low BMI is the only individual index which demonstrated a trend toward being a significant predictor of mortality. Patients with low BMI should be carefully assessed prior to TAVR.