Baylor Health Care System, The Heart Hospital, Plano, Tex, USA.
J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S7-10. doi: 10.1016/j.jtcvs.2012.11.063. Epub 2012 Dec 20.
Frailty is a common occurrence in elderly persons and is present in approximately half of the patients being screened for transcatheter aortic valve replacement (TAVR) therapy. Accurate assessment of the likelihood of benefit from intervention in the older patient with aortic stenosis is critical with both surgical aortic valve replacement and TAVR now available. Whereas risk algorithms are available that are helpful in predicting outcomes in patients undergoing surgical procedures, measures of frailty are not included in the algorithms. When considering intervention in the elderly patient, the addition of frailty assessment to determine the true risk in this population is essential to determine potential benefit. Gait speed as determined by the 5-m walk test is the most commonly used single test objective measurement of frailty in patients undergoing cardiac surgery and is an independent predictor of mortality and major morbidity. Wider application of this and other objective measures of frailty in the population undergoing TAVR is necessary to determine whether it is predictive in this population also.
衰弱是老年人中常见的现象，大约有一半接受经导管主动脉瓣置换术（TAVR）治疗筛查的患者存在这种情况。对于患有主动脉瓣狭窄的老年患者，无论是进行主动脉瓣置换术还是 TAVR，准确评估干预获益的可能性都至关重要。虽然有风险算法可用于预测接受手术治疗的患者的结局，但衰弱的衡量标准并未包含在算法中。在考虑对老年患者进行干预时，必须通过衰弱评估来确定该人群的真正风险，以确定潜在获益。通过 5 米步行测试确定的步态速度是心脏手术患者中最常用的单一测试，是死亡率和主要发病率的独立预测指标。在接受 TAVR 的人群中更广泛地应用这一测试和其他客观的衰弱衡量标准，以确定它是否也可以预测该人群。
