Original Title: Poor Mobility Predicts Adverse Outcomes Better Than Other Frailty Indices in Patients Undergoing Transcatheter Aortic Valve Implantation. Reference: James Cockburn, et al. Catheterization and Cardiovascular Intervention 2015;86:1271-1277
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foudation – Buenos Aires
There is a group of high risk patients that are also fragile, and there is still no definition on the best indices to assess them and predict how they would benefit from a transcatheter aortic valve replacement (TAVI).
The study included 312 patients assessed by different mobility and frailty tests.
Mean age was 81, mostly men, aortic valve area was 0.72 cm2 and gradient 80 mmHg. Logistic EuroSCORE and STS were 17.4±9.4 and 4.6±2.8. 20% presented heart disease.
Nearly 90% of procedures were via femoral and percutaneous closure was used in more than 80% of cases; the most frequently implanted valve was the CoreValve. Most procedures were performed with local anesthesia plus sedation.
In multivariable analysis, poor mobility (because of muscle, skeletal or neurologic dysfunction) was the best predictor of negative evolution at short and long term.
Conclusion
Poor mobility predicts worse evolution at short and long term in patients undergoing TAVI. These data suggest it would be necessary to assess mobility when screening patients undergoing TAVI.
Commentary
Although there are different frailty tests available, they have not been designed for this group of patients. This is the first study to assess mobility and it does not show its evolution at short and long term. It is necessary to design a frailty test for TAVI; in the meantime, mobility may be the best way to define what patients will benefit from this strategy.