Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada.
BMC Cardiovasc Disord. 2020 Jun 18;20(1):299. doi: 10.1186/s12872-020-01572-4.
Few studies have measured frailty as a potential reason for foregoing transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis (AS). This study sought to determine the impact of frailty and other clinician-cited reasons on restricted mean survival time (RMST).
An analysis of the McGill Frailty Registry was conducted between 2014 and 2018 at the McGill University Health Center Structural Valve Clinic. Consecutive nonsurgical patients referred for TAVR were included. In those that underwent balloon aortic valvuloplasty or medical management, the primary clinician-cited reason for foregoing TAVR was codified. Vital status was ascertained at 1 year and analysed using RMST and Kaplan-Meier analyses.
The study consisted of 373 patients with a mean age of 82.4 years, of which 233 underwent TAVR and 140 did not. Patients who did not undergo TAVR were more likely to be nonagenarians, with left ventricular dysfunction, chronic kidney disease, dementia, disability, depression, malnutrition, and frailty. The primary clinician-cited reason was: comorbidity in 34%, frailty in 23%, procedural feasibility and risks in 16%, and mild or unrelated symptoms in 27%. Compared to the TAVR group, 1-year RMST was reduced by 2.0 months in the medical management group (95% CI 1.2, 2.7) and by 1.1 months in the valvuloplasty group (95% CI -0.2, 2.5).
Patients with severe AS referred for TAVR may never undergo the procedure on the basis of comorbidity, frailty, procedural issues, and symptoms. The best treatment decision is one that follows from multi-disciplinary assessment encompassing frailty.
很少有研究将衰弱作为老年严重主动脉瓣狭窄（AS）患者不接受经导管主动脉瓣置换术（TAVR）的潜在原因进行测量。本研究旨在确定衰弱和其他临床医生引用的原因对受限平均生存时间（RMST）的影响。
2014 年至 2018 年，在麦吉尔大学健康中心结构性瓣膜诊所对麦吉尔衰弱登记处进行了分析。纳入连续的非手术患者，这些患者因 TAVR 而转诊。在接受球囊主动脉瓣成形术或药物治疗的患者中，对不接受 TAVR 的主要临床医生引用的原因进行了编码。在 1 年时确定了生存状态，并使用 RMST 和 Kaplan-Meier 分析进行了分析。
该研究共纳入 373 名平均年龄为 82.4 岁的患者，其中 233 名接受了 TAVR，140 名未接受。未接受 TAVR 的患者更有可能是 90 岁以上的老年人，伴有左心室功能障碍、慢性肾脏病、痴呆、残疾、抑郁、营养不良和衰弱。主要临床医生引用的原因是：合并症占 34%，衰弱占 23%，程序可行性和风险占 16%，轻度或无关症状占 27%。与 TAVR 组相比，药物治疗组的 1 年 RMST 缩短了 2.0 个月（95%CI 1.2，2.7），球囊成形术组缩短了 1.1 个月（95%CI -0.2，2.5）。
因合并症、衰弱、程序问题和症状而被转诊接受 TAVR 的严重 AS 患者可能永远不会接受该手术。最佳治疗决策是根据多学科评估做出的，该评估包括衰弱。
