Unit of Geriatrics and Metabolic Bone Diseases, University of Turin, City of Health and Sciences, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy.
Division of Cardiac Surgery, Department of Surgical Sciences, City of Health and Sciences, Molinette Hospital, Corso Bramante 88, 10126, Turin, Italy.
Aging Clin Exp Res. 2020 Mar;32(3):381-388. doi: 10.1007/s40520-019-01228-0. Epub 2019 May 30.
Among elderly with severe aortic stenosis (AS), Comprehensive Geriatric Assessment (CGA) originally contributed to address to transcatheter aortic valve implantation (TAVI) patients not suitable to surgical aortic valve replacement(SAVR). Nevertheless, TAVI has recently been proposed also in lower surgical risk patients.
To evaluate predictors of TAVI procedure and clinical outcomes among these patients.
For each patient ≥ 65 years with severe AS referring to our Cardiac Surgery Division, CGA was performed, including functional and cognitive status, comorbidity burden, frailty, nutritional status, gait speed, hand-grip strength and number of medications. Surgical risk was evaluated according to the Society of Thoracic Surgeons (STS) score (low-risk < 4%). Post-procedural outcomes (30-day survival and post-procedural complications) were obtained by medical records and a one-year follow-up assessed survival, and functional and cognitive performance.
Among 154 subjects (mean age 82.9 years), 52 were at low-risk according to STS score. 32 patients were addressed to TAVI, 20 to SAVR. Variables significantly associated with TAVI-approach were lower gait speed (p 0.030) and higher number of medications (p 0.015). Short and long-term outcomes did not differ between groups.
Among CGA variables, gait speed and number of medications were associated with the decision to perform TAVI instead of SAVR, even in patients at low surgical risk. 30-day and one-year survival and one-year functional and cognitive decline were similar between groups, despite a relevant prevalence of frailty in the TAVI group.
We suggest that gait speed and number of medications should be considered in selecting appropriate candidates to TAVI among low surgical risk patients.
在患有严重主动脉瓣狭窄（AS）的老年患者中，综合老年评估（CGA）最初旨在确定不适合接受外科主动脉瓣置换术（SAVR）的经导管主动脉瓣植入术（TAVI）患者。然而，最近也提出了在低手术风险患者中进行 TAVI 的建议。
评估这些患者行 TAVI 术的预测因素和临床结局。
对于每个因严重 AS 而转至我院心脏外科的年龄≥65 岁的患者，均进行 CGA，包括功能和认知状态、合并症负担、虚弱、营养状况、步态速度、手握力和用药数量。根据胸外科医师学会（STS）评分（低危<4%）评估手术风险。通过病历获得术后结局（30 天生存率和术后并发症），并通过一年随访评估生存率以及功能和认知表现。
在 154 名患者中（平均年龄 82.9 岁），52 名患者根据 STS 评分属于低危。32 名患者接受了 TAVI 治疗，20 名患者接受了 SAVR 治疗。与 TAVI 方法显著相关的变量是较低的步态速度（p=0.030）和较高的用药数量（p=0.015）。两组之间的短期和长期结局没有差异。
在 CGA 变量中，步态速度和用药数量与决定行 TAVI 而非 SAVR 相关，即使在低手术风险的患者中也是如此。两组之间 30 天和 1 年生存率以及 1 年功能和认知下降相似，尽管 TAVI 组中虚弱的发生率较高。
我们建议，在选择低手术风险患者进行 TAVI 时，应考虑步态速度和用药数量。
