Preoperative Frailty Affects Postoperative Complications, Exercise Capacity, and Home Discharge Rates After Surgical and Transcatheter Aortic Valve Replacement

Overview

Journal Heart Vessels

Specialty Cardiology & Vascular Diseases

Date 2021 Feb 22

PMID 33615425

Citations 3

Authors

Kodai Komaki

Naofumi Yoshida

Seimi Satomi-Kobayashi

Yasunori Tsuboi

Masato Ogawa

Kumiko Wakida

Takayoshi Toba

Hiroyuki Kawamori

Hiromasa Otake

Atsushi Omura

Katsuhiro Yamanaka

Takeshi Inoue

Tomoya Yamashita

Yoshitada Sakai

Kazuhiro P Izawa

Kenji Okada

Ken-Ichi Hirata

Affiliations

Soon will be listed here.

Abstract

Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.

Citing Articles

Clinical Impact of Preoperative Symptoms of Aortic Stenosis on Prognosis After Transcatheter Aortic Valve Replacement.

Kemi Y, Yamashita E, Kario K, Kinoshita S, Sugano K, Yano H Circ Rep. 2024; 6(6):223-229.

PMID: 38860183 PMC: 11162866. DOI: 10.1253/circrep.CR-24-0020.

The Incidence and Influencing Factors of In-hospital Frailty Progression following Transcatheter Aortic Valve Implantation.

Miyazaki T, Tanaka A, Tokuda Y, Shirai Y, Mizutani K, Furusawa K Intern Med. 2024; 63(24):3283-3289.

PMID: 38719603 PMC: 11729170. DOI: 10.2169/internalmedicine.3146-23.

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses.

Zou J, Yuan J, Liu J, Geng Q Front Cardiovasc Med. 2023; 10:1164104.

PMID: 38152609 PMC: 10751363. DOI: 10.3389/fcvm.2023.1164104.

Inspiratory Muscle and Functional Performance of Patients Entering Cardiac Rehabilitation after Cardiac Valve Replacement.

Gempel S, Cohen M, Milian E, Vidret M, Smith A, Jones I J Cardiovasc Dev Dis. 2023; 10(4).

PMID: 37103021 PMC: 10141801. DOI: 10.3390/jcdd10040142.

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