Fernández-González Andoni, Molero-de-Ávila Rodrigo, Cedeño-Veloz Bernardo Abel, Fernández-Jarne Elena, Lozano-Vicario Lucia, Ramallal Martínez Raúl, Martínez-Velilla Nicolas, Alonso Salinas Gonzalo Luis
Cardiology Department, Navarre University Hospital (HUN), Navarre Health Service (SNS-O). Irunlarrea St 3, 31008 Pamplona, Spain.
Geriatrics Department, Navarre University Hospital (HUN), Navarre Health Service (SNS-O). Irunlarrea St 3, 31008 Pamplona, Spain.
Medicina (Kaunas). 2025 Aug 23;61(9):1515. doi: 10.3390/medicina61091515.
Transcatheter Aortic Valve Replacement (TAVR) has revolutionized the management of severe aortic stenosis (AS), offering a less invasive alternative to surgical replacement, which is particularly beneficial for elderly and high-risk populations. This narrative review aims to summarize current evidence regarding TAVR's clinical outcomes, patient selection, the role of cardiac remodeling, and the impact of geriatric syndromes on procedural success. This review is based on a comprehensive analysis of the peer-reviewed literature indexed in major scientific databases. We included relevant studies addressing TAVR in older adults, focusing on cardiac biomarkers, imaging, patient stratification, and geriatric syndromes, such as frailty, delirium, and sarcopenia. Evidence indicates that TAVR significantly improves survival and quality of life in elderly patients with severe AS. Advanced cardiac imaging and biomarkers contribute to improved risk stratification and post-procedural management. Geriatric syndromes are prevalent in this population and strongly influence clinical outcomes. Tailored prehabilitation and multidisciplinary approaches are increasingly recognized as critical components of TAVR care. TAVR is an effective and safe option for older adults with severe AS. Optimal outcomes depend not only on procedural expertise but also on recognizing and addressing the complex interplay between cardiac pathology and geriatric vulnerabilities. A holistic, patient-centered approach is essential to maximize the therapeutic benefits in this growing patient population.
经导管主动脉瓣置换术（TAVR）彻底改变了严重主动脉瓣狭窄（AS）的治疗方式，为外科置换提供了一种侵入性较小的替代方案，这对老年和高危人群尤其有益。本叙述性综述旨在总结关于TAVR临床结果、患者选择、心脏重塑的作用以及老年综合征对手术成功影响的现有证据。本综述基于对主要科学数据库中索引的同行评审文献的全面分析。我们纳入了针对老年人TAVR的相关研究，重点关注心脏生物标志物、影像学、患者分层以及老年综合征，如衰弱、谵妄和肌肉减少症。证据表明，TAVR显著提高了严重AS老年患者的生存率和生活质量。先进的心脏影像学和生物标志物有助于改善风险分层和术后管理。老年综合征在该人群中普遍存在，并强烈影响临床结果。量身定制的术前康复和多学科方法越来越被认为是TAVR护理的关键组成部分。TAVR对于患有严重AS的老年人是一种有效且安全的选择。最佳结果不仅取决于手术专业知识，还取决于认识和解决心脏病理学与老年易损性之间的复杂相互作用。一种全面的、以患者为中心的方法对于在这一不断增长的患者群体中最大化治疗益处至关重要。
