Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Catheter Cardiovasc Interv. 2022 Sep;100(3):439-448. doi: 10.1002/ccd.30320. Epub 2022 Jul 13.
Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement for patients who are at increased surgical risk. Consequently, frailty is common in patients undergoing TAVR.
This study aims to investigate the impact of frailty on outcomes following TAVR.
A retrospective cohort study was conducted, including all TAVR candidates who visited the geriatric outpatient clinic for preoperative screening. Frailty status was assessed according to the Groningen Frailty Indicator. The primary outcome of the study was defined as the occurrence of postoperative complications, and this was evaluated according to the Clavien-Dindo classification. An additional analysis was performed to assess the impact of frailty on 1-year all-cause mortality and complications within 30 days of TAVR according to the Valve Academic Research Consortium (VARC-2) criteria. The VARC-2 criteria provide harmonized endpoint definitions for TAVR studies.
In total, 431 patients with a mean age of 80.8 ± 6.2 years were included, of whom 56% were female. Frailty was present in 36% of the participants. Frailty was associated with a higher risk of the composite outcome of complications [adjusted odds ratio (OR): 1.55 (95% confidence interval, CI: 1.03-2.34)], 30-day mortality [adjusted OR: 4.84 (95% CI: 1.62-14.49)], 3-month mortality [adjusted OR: 2.52 (95% CI: 1.00-6.28)] and 1-year mortality [adjusted OR: 2.96 (95% CI: 1.46-6.00)].
Frailty is common in TAVR patients and is associated with an increased overall risk of postoperative complications, particularly mortality. Increased optimization of screening and treatment of frailty in the guidelines for valvular heart diseases is recommended.
经导管主动脉瓣置换术（TAVR）是一种治疗高危外科主动脉瓣置换术的有效替代方法。因此，在接受 TAVR 的患者中，衰弱是常见的。
本研究旨在探讨衰弱对 TAVR 术后结局的影响。
进行了一项回顾性队列研究，纳入所有在老年门诊接受术前筛查的 TAVR 候选患者。根据格罗宁根衰弱指数评估衰弱状态。研究的主要结局定义为术后并发症的发生，并根据 Clavien-Dindo 分类进行评估。还进行了一项额外的分析，以根据 Valve Academic Research Consortium（VARC-2）标准评估衰弱对 TAVR 后 1 年全因死亡率和 30 天内并发症的影响。VARC-2 标准为 TAVR 研究提供了协调的终点定义。
共纳入 431 名平均年龄 80.8±6.2 岁的患者，其中 56%为女性。36%的参与者存在衰弱。衰弱与并发症复合结局的风险增加相关[调整后的优势比（OR）：1.55（95%置信区间，CI：1.03-2.34）]、30 天死亡率[调整后的 OR：4.84（95% CI：1.62-14.49）]、3 个月死亡率[调整后的 OR：2.52（95% CI：1.00-6.28）]和 1 年死亡率[调整后的 OR：2.96（95% CI：1.46-6.00）]。
衰弱在 TAVR 患者中很常见，与术后并发症总体风险增加相关，尤其是死亡率。建议在瓣膜性心脏病指南中增加对衰弱的筛查和治疗优化。
