TAVI Frailty Indices: We Should Start Using Them

Courtesy of Dr. Carlos Fava.

Frailty should be taken into account when deciding transcatheter aortic valve implantation (TAVI). Even though several scales of frailty are available, they are yet to be tested in this group, with this strategy.

The study analyzed 101 patients, frailty was assessed clinically according to the following tests:

• Katz index of Independence of Activity in Daily Living (KI of ADL),
• Elderly Mobility Scale (EMS),
• Canadian Study of Health and Aging (CSHA),
• 5-meters walking test (5MWT),
• Hand Grip,
• Identification Senior at Risk.

Population mean age was 81, 61 patients were women, most were symptomatic and in functional class III/IV. Mean aortic area was 0.6 (0.4 to 0.8) cm² and mean gradient was 87 (71-108) mmHg. EuroSCORE I was 16.5% and STS score was 15.4%.

91.1% of procedures was performed under general anesthesia, and the transfemoral was the most used approach (77.2%), followed by the transapical (20.8%) and the aortic (2%).

At one year, all-cause mortality was 17.8%. According to 5MWT, 17.8% were frail, CSHA scale 16.9%, Katz Index 17.8%, Hand Grip 6.9% and ISAR 52.5%. Frailty indices were strongly associated to all-cause mortality at one year.

Adjusted analysis confirmed the association between the different indices of frailty and all-cause mortality at one year. Small changes in the 5MWT (1 second increase), EMS (one point reduction) and one CSHA increase (one point) resulted in a three-fold mortality increase.

Conclusion

This study confirms most frailty indices have a strong capacity to predict mortality at 12 months. In TAVI candidates, the use of frailty indices such as the 5MWT, EMS, and the Hand Grip test, yield good results.

Editorial Comment

Frailty is increasingly being evaluated in TAVI candidates. This analysis shows that, even though there is no specific test to assess frailty, the combination of them provides significant information on high risk groups, however difficult it may be to leave out a patient based on this assessment. We still require further information, we should continue to research to find out which one group will not benefit of transcatheter aortic valve implantation procedures.

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.

Original Title: Impact of frailty on mortality after transcatheter aortic valve implantation.

Reference: Pawel Kleczynski, et al. Am Heart J 2017;185:52-8.

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