Author + information
- Received November 6, 2019
- Revision received January 21, 2020
- Accepted January 22, 2020
- Published online May 4, 2020.
- Melissa Bendayan, MSca,b,
- Nathan Messas, MDc,
- Louis P. Perrault, MD, PhDd,
- Anita W. Asgar, MD, MSce,
- Sandra Lauck, PhDf,
- Dae H. Kim, MD, ScDg,
- Rakesh C. Arora, MD, PhDh,
- Yves Langlois, MDi,
- Nicolo Piazza, MD, PhDj,
- Giuseppe Martucci, MDj,
- Thierry Lefèvre, MDk,
- Nicolas Noiseux, MD, MScl,
- Andre Lamy, MDm,
- Mark D. Peterson, MD, PhDn,
- Marino Labinaz, MDo,
- Jeffrey J. Popma, MDp,
- John G. Webb, MDf and
- Jonathan Afilalo, MD, MSca,b,c,∗ ()
- aDivision of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- bCentre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
- cDivision of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- dDivision of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
- eDivision of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
- fCentre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- gDivision of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
- hDivisions of Cardiac Surgery and Critical Care, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba
- iDivision of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- jDivision of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
- kDivision of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
- lDivision of Cardiac Surgery, Center Hospitalier de l’Université de Montréal, Centre de Recherche du CHUM, Montreal, Quebec
- mDivision of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- nDivision of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- oDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- pDivision of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Jonathan Afilalo, Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste. Catherine Road, E-222, Montreal, QC H3T 1E2, Canada.
Objectives The aim of this study was to examine the value of frailty to predict in-hospital major bleeding and determine its impact on mid-term mortality following transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.
Background Bleeding complications are harbingers of mortality and major morbidity in patients undergoing TAVR or SAVR. Despite the high prevalence of frailty in this population, little is known about its effects on bleeding risk.
Methods A post hoc analysis was performed of the multinational FRAILTY-AVR (Frailty Aortic Valve Replacement) cohort study, which prospectively enrolled older adults ≥70 years of age undergoing TAVR or SAVR. Trained researchers assessed frailty using a questionnaire and physical performance battery pre-procedure and ascertained clinical data from the electronic health record. The primary endpoint was major or life-threatening bleeding during the index hospitalization, and the secondary endpoint was units of packed red blood cells transfused.
Results The cohort consisted of 1,195 patients with a mean age of 81.3 ± 6.0 years. The incidence of life-threatening bleeding, major bleeding with a clinically apparent source, and major bleeding without a clinically apparent source was, respectively, 3%, 6%, and 9% in the TAVR group and 8%, 10%, and 31% in the SAVR group. Frailty measured using the Essential Frailty Toolset was an independent predictor of major bleeding and packed red blood cell transfusions in both groups. Major bleeding was associated with a 3-fold increase in 1-year mortality following TAVR (odds ratio: 3.40; 95% confidence interval: 2.22 to 5.21) and SAVR (odds ratio: 2.79; 95% confidence interval: 1.25 to 6.21).
Conclusions Frailty is associated with post-procedural major bleeding in older adults undergoing TAVR and SAVR, which is in turn associated with a higher risk for mid-term mortality.
Dr. Messas has received educational grants from Medtronic Canada, Biosensors France, and Hexacath France. Dr. Perrault has served as a consultant to Somahlution; and has served on the advisory board of Clearflow. Dr. Kim has served as a consultant to Alosa Health (nonprofit). Dr. Arora has received an unrestricted educational grant from Pfizer; has received honoraria from Mallickrodt Pharmaceutical, Abbott Nutrition, and Edwards Lifesciences; and has served on the advisory board for CSU-ALS North America. Dr. Lefèvre has been a proctor for Edwards Lifesciences. Dr. Piazza has served as a consultant to Highlife, Microport, and Medtronic. Dr. Martucci has served as a consultant to Boston Scientific; and has been a proctor for Boston Scientific and Medtronic. Dr. Lauck has served as a consultant to Edwards Lifesciences. Dr. Peterson has been a proctor for Edwards Lifesciences; and has served as a consultant for Edwards Lifesciences and LivaNova. Dr. Asgar has served as a consultant to Edwards Lifesciences and Medtronic. Dr. Popma has received institutional grants from Medtronic; and has served on the advisory boards of Boston Scientific (noncompensated), Edwards Lifesciences (compensated), and Medtronic (noncompensated). Dr. Webb has served as a consultant to Edwards Lifesciences and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Bernard Prendergast, DM, served as Guest Editor for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received November 6, 2019.
- Revision received January 21, 2020.
- Accepted January 22, 2020.
- 2020 American College of Cardiology Foundation
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