Clin Res Cardiol 101, Suppl 1, April 2012

V1145 - Impact of Frailty on Short-term TAVI Outcome
 
F. Woitek1, M. Uhlemann1, N. Mangner1, S. Möbius-Winkler1, D. Holzhey2, F. W. Mohr2, G. C. Schuler1, A. Linke1
 
1Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum GmbH, Leipzig; 2Klinik für Herzchirurgie, Herzzentrum der Universität Leipzig, Leipzig;
 
In older high risk patients (pts) with aortic valve stenosis (AS) current risk scores fail to predict postoperative or postinterventional outcome. This might be due to the fact that frailty is not incorporated into any of these scores. Therefore, aim of this study was to elucidate whether established frailty assessment tools help to predict outcome after TAVI in a selected cohort.
Methods: TAVI pts were assessed prospectively regarding there over all appearance by two independent physicians using a numerical score from 1 (frail) to 10 (good condition). Additionally, Katz activity score, gait speed testing, a five feet walk test and a hand grip strength test were performed. At 30days, clinical data as well as VARC safety endpoints were analysed with respect to the frailty.
Results: A total of 75pts (age 81±6 years) with a Logistic EuroSCORE of 20.6±12.7% received TAVI under local anaesthesia. Almost ¾ of the patients received a Medtronic CoreValve prosthesis, whereas 19 pts received an Edwards Sapien XT. The mean gradient declined from 67.0±12.3mmHg before to 12.0±7.5mmHg after TAVI. VARC device success was achieved in 97.3% of the pts. The VARC combined safety endpoint of death, procedural MI, lifethreatening bleeding, major stroke or kidney failure Stage 3 occurred in 24% of the patients, mainly driven by major access site complications (14.67%). During 30days of follow-up one pt died due to an intracranial haemorrhage and one pt experienced a major ischemic stroke. Thus, the rate of major stroke and death was 2.67%.
Mean appearance score was 6.3±1.7, mean Katz activity score 5.4±1.4, mean time to overcome five-feet was 8.5±4.2 seconds and mean hand grip strength of the dominant hand was 20.2±8.5 Kg.
Even though that hand grip strength and Katz score are reflecting frailty, there was no significant predictive value of these two tests on the combined safety endpoint according the VARC definitions (p= 0,938; 0,925-1,089; p= 0,301; 0,526-1,222). In addition the walking speed failed to reached the level of statistical significance (p= 0,06; 0,991-1,529) in this relatively small cohort. Only the overall assessment score by the treating physicians had (p= 0,015; 0,280-0,873) a significant value predicting the occurrence of the combined VARC safety endpoint.
Conclusion: Transfemoral aortic valve implantation in older patients with higher risk for conventional surgery is safe, feasible and reliable and provides good hemodynamic results. Individual clinical judgment remains crucial to insure beneficial outcome for the patient. However, only the appearance was able to predict complications underlining the importance of the “eye ball test” before TAVI.
 
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/V1145.htm