Skip to main content

Advertisement

Log in

Transcatheter aortic valve implantation and frailty

  • Invited Review Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

Over the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a treatment option for patients with severe aortic stenosis. With exponential increase in the number of TAVI procedures, frailty assessments have been considered important for patients undergoing TAVI, and a number of studies have indicated a relationship between the frailty and post-TAVI outcomes. In this review, using studies searched systematically in the PubMed database, we review important frailty assessment tools that can be used as prognostic factors for patients before TAVI. The assessment tools were categorized as quantitative single marker, semi-quantitative single marker, or quantitative combined marker. Studies were further stratified by whether they used frailty markers to predict patients’ prognosis pre-TAVI or to evaluate frailty improvement post-TAVI. The Clinical Frailty Scale (CFS), a semi-quantitative assessment, is one of the frailty assessment tools discussed. It may be easily used even in an outpatient consultation room. The CFS classifies patients’ activity into nine categories, based on a simple interview and the patient’s appearance. Gait speed and serum albumin levels were considered as qualitative frailty assessment tools. Compared to other methods, the Essential Frailty Toolset had the highest inter-rater reliability for accuracy in predicting mortality, thereby allowing better identification of vulnerable old age people and optimization of outcomes. A few studies have also focused on changes in frailty pre- and post-TAVI. Serum albumin-level measurements are important for assessing the frailty improvement in the chronic phase. Each frailty assessment tool had its own characteristics, strengths, and weaknesses, and therefore, these tools need to be selected based on where they are being used and the patient's condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Data availability

Data and study materials will not be made available to other researchers for purposes of reproducing the results because of the terms of our data use agreements.

References

  1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines. J Am Coll Cardiol. 2017;70:252–89. https://doi.org/10.1016/j.jacc.2017.03.011.

    Article  PubMed  Google Scholar 

  2. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association joint Committee on Clinical Practice guidelines. Circulation. 2021;143:e72–227. https://doi.org/10.1161/CIR.0000000000000923.

    Article  PubMed  Google Scholar 

  3. Kurazumi H, Suzuki R, Shirasawa B, Miyazaki Y, Tateishi H, Oda T, et al. Early and long-term outcomes of transcatheter aortic valve replacement for selected nonagenarians in Japan. Circ J. 2022. https://doi.org/10.1253/circj.CJ-21-0949.

    Article  PubMed  Google Scholar 

  4. Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76. https://doi.org/10.1016/j.jacc.2010.06.039.

    Article  PubMed  Google Scholar 

  5. Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012;5:222–8. https://doi.org/10.1161/CIRCOUTCOMES.111.963157.

    Article  PubMed  Google Scholar 

  6. Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: A single center experience. JACC Cardiovasc Interv. 2012;5:974–81. https://doi.org/10.1016/j.jcin.2012.06.011.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stortecky S, Schoenenberger AW, Moser A, Kalesan B, Jüni P, Carrel T, et al. Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. JACC Cardiovasc Intv. 2012;5:489–96. https://doi.org/10.1016/j.jcin.2012.02.012.

    Article  Google Scholar 

  8. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9. https://doi.org/10.1001/jama.1963.03060120024016.

    Article  CAS  PubMed  Google Scholar 

  9. Green P, Arnold SV, Cohen DJ, Kirtane AJ, Kodali SK, Brown DL, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). Am J Cardiol. 2015;116:264–9. https://doi.org/10.1016/j.amjcard.2015.03.061.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Huded CP, Huded JM, Friedman JL, Benck LR, Lindquist LA, Holly TA, et al. Frailty status and outcomes after transcatheter aortic valve implantation. Am J Cardiol. 2016;117:1966–71. https://doi.org/10.1016/j.amjcard.2016.03.044.

    Article  PubMed  Google Scholar 

  11. Alfredsson J, Stebbins A, Brennan JM, Matsouaka R, Afilalo J, Peterson ED, et al. Gait speed predicts 30-day mortality after transcatheter aortic valve replacement. Circulation. 2016;133:1351–9. https://doi.org/10.1161/CIRCULATIONAHA.115.020279.

    Article  CAS  PubMed  Google Scholar 

  12. Kano S, Yamamoto M, Shimura T, Kagase A, Tsuzuki M, Kodama A, et al. Gait speed can predict advanced clinical outcomes in patients who undergo transcatheter aortic valve replacement: Insights From a Japanese Multicenter Registry. Circ Cardiovasc Interv. 2017;10: e005088. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005088.

    Article  PubMed  Google Scholar 

  13. Yamamoto M, Shimura T, Kano S, Kagase A, Kodama A, Sago M, et al. Prognostic value of hypoalbuminemia after transcatheter aortic valve implantation (from the Japanese Multicenter OCEAN-TAVI Registry). Am J Cardiol. 2017;119:770–7. https://doi.org/10.1016/j.amjcard.2016.11.019.

    Article  CAS  PubMed  Google Scholar 

  14. Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation. 2017;135:2013–24. https://doi.org/10.1161/CIRCULATIONAHA.116.025630.

    Article  PubMed  Google Scholar 

  15. Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, et al. Frailty in older adults undergoing aortic valve replacement: The FRAILTY-AVR study. J Am Coll Cardiol. 2017;70:689–700. https://doi.org/10.1016/j.jacc.2017.06.024.

    Article  PubMed  Google Scholar 

  16. Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, et al. Impact of frailty on mortality after transcatheter aortic valve implantation. Am Heart J. 2017;185:52–8. https://doi.org/10.1016/j.ahj.2016.12.005.

    Article  PubMed  Google Scholar 

  17. Kagase A, Yamamoto M, Shimura T, Kano S, Tsuzuki M, Kodama A, et al. Sex-specific grip strength after transcatheter aortic valve replacement in elderly patients. JACC Cardiovasc Intv. 2018;11:100–1. https://doi.org/10.1016/j.jcin.2017.06.055.

    Article  Google Scholar 

  18. Yanagisawa R, Tanaka M, Yashima F, Arai T, Kohno T, Shimizu H, et al. Frequency and consequences of cognitive impairment in patients underwent transcatheter aortic valve implantation. Am J Cardiol. 2018;122:844–50. https://doi.org/10.1016/j.amjcard.2018.05.026.

    Article  PubMed  Google Scholar 

  19. Shibata K, Yamamoto M, Kano S, Koyama Y, Shimura T, Kagase A, et al. Importance of Geriatric Nutritional Risk Index assessment in patients undergoing transcatheter aortic valve replacement. Am Heart J. 2018;202:68–75. https://doi.org/10.1016/j.ahj.2018.04.021.

    Article  PubMed  Google Scholar 

  20. Hosler QP, Maltagliati AJ, Shi SM, Afilalo J, Popma JJ, Khabbaz KR, et al. A practical two-stage frailty assessment for older adults undergoing aortic valve replacement. J Am Geriatr Soc. 2019;67:2031–7. https://doi.org/10.1111/jgs.16036.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Okuno T, Koseki K, Nakanishi T, Sato K, Ninomiya K, Tomii D, et al. Evaluation of objective nutritional indexes as predictors of one-year outcomes after transcatheter aortic valve implantation. J Cardiol. 2019;74:34–9. https://doi.org/10.1016/j.jjcc.2019.02.017.

    Article  PubMed  Google Scholar 

  22. Abdul-Jawad Altisent O, Puri R, Regueiro A, Chamandi C, Rodriguez-Gabella T, Del Trigo M, et al. Predictors and association with clinical outcomes of the changes in exercise capacity after transcatheter aortic valve replacement. Circulation. 2017;136:632–43. https://doi.org/10.1161/CIRCULATIONAHA.116.026349.

    Article  PubMed  Google Scholar 

  23. Shimura T, Yamamoto M, Kano S, Sago M, Tsunaki T, Kagase A, et al. Predictors and prognostic impact of nutritional changes after transcatheter aortic valve replacement. Cardiovasc Revasc Med. 2021;23:68–76. https://doi.org/10.1016/j.carrev.2020.08.031.

    Article  PubMed  Google Scholar 

  24. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–57. https://doi.org/10.1093/gerona/56.3.M146.

    Article  CAS  PubMed  Google Scholar 

  25. Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: The Valve Academic Research Consortium-2 consensus document. Eur Heart J. 2012;33:2403–18. https://doi.org/10.1093/eurheartj/ehs255.

    Article  PubMed  Google Scholar 

  26. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95. https://doi.org/10.1503/cmaj.050051.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rockwood K, Theou O. Using the clinical frailty scale in allocating scarce health care resources. Can Geriatr J. 2020;23:210–5. https://doi.org/10.5770/cgj.23.463.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lawman HG, Troiano RP, Perna FM, Wang CY, Fryar CD, Ogden CL. Associations of relative handgrip strength and cardiovascular disease biomarkers in US adults, 2011–2012. Am J Prev Med. 2016;50:677–83. https://doi.org/10.1016/j.amepre.2015.10.022.

    Article  PubMed  Google Scholar 

  29. Chen PJ, Lin MH, Peng LN, Liu CL, Chang CW, Lin YT, et al. Predicting cause-specific mortality of older men living in the Veterans home by handgrip strength and walking speed: A 3-year, prospective cohort study in Taiwan. J Am Med Dir Assoc. 2012;13:517–21. https://doi.org/10.1016/j.jamda.2012.02.002.

    Article  PubMed  Google Scholar 

  30. Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM. Handgrip strength and cause-specific and total mortality in older disabled women: Exploring the mechanism. J Am Geriatr Soc. 2003;51:636–41. https://doi.org/10.1034/j.1600-0579.2003.00207.x.

    Article  PubMed  Google Scholar 

  31. Khan MM, Lanctôt KL, Fremes SE, Wijeysundera HC, Radhakrishnan S, Gallagher D, et al. The value of screening for cognition, depression, and frailty in patients referred for TAVI. Clin Interv Aging. 2019;14:841–8. https://doi.org/10.2147/CIA.S201615.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Saji M, Tobaru T, Higuchi R, Hagiya K, Takamisawa I, Shimizu J, et al. Cognitive assessment using the revised Hasegawa’s dementia scale to determine the mid-term outcomes following transcatheter aortic valve replacement. J Cardiol. 2019;74:206–11. https://doi.org/10.1016/j.jjcc.2019.03.017.

    Article  PubMed  Google Scholar 

  33. Luan Erfe BM, Erfe JM, Brovman EY, Boehme J, Bader AM, Urman RD. Postoperative outcomes in SAVR/TAVR patients with cognitive impairment: A systematic review. Semin Thorac Cardiovasc Surg. 2019;31:370–80. https://doi.org/10.1053/j.semtcvs.2018.11.017.

    Article  PubMed  Google Scholar 

  34. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777–83. https://doi.org/10.1093/ajcn/82.4.777.

    Article  CAS  PubMed  Google Scholar 

  35. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24. https://doi.org/10.1186/1471-2318-8-24.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27:17–26. https://doi.org/10.1016/j.cger.2010.08.008.

    Article  PubMed  Google Scholar 

  37. Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, González P, González B, Mancha A, et al. CONUT: A tool for controlling nutritional status First validation in a hospital population. Nutr Hosp. 2005;20:38–45. https://doi.org/10.1016/j.cger.2010.08.008.

    Article  PubMed  Google Scholar 

  38. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  39. Green P, Cohen DJ, Généreux P, McAndrew T, Arnold SV, Alu M, et al. Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER trial). Am J Cardiol. 2013;112:700–6. https://doi.org/10.1016/j.amjcard.2013.04.046.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mok M, Nombela-Franco L, Urena M, Delarochellière R, Doyle D, Ribeiro HB, et al. Prognostic value of exercise capacity as evaluated by the 6-minute walk test in patients undergoing transcatheter aortic valve implantation. J Am Coll Cardiol. 2013;61:897–8. https://doi.org/10.1016/j.jacc.2012.10.050.

    Article  PubMed  Google Scholar 

  41. Mok M, Nombela-Franco L, Dumont E, Urena M, DeLarochellière R, Doyle D, et al. Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: Insights on clinical outcomes, prognostic markers, and functional status changes. JACC Cardiovasc Intv. 2013;6:1072–84. https://doi.org/10.1016/j.jcin.2013.06.008.

    Article  Google Scholar 

Download references

Acknowledgements

I would like to express my sincere gratitude to the investigators and institutions that have participated in the OCEAN-TAVI registry.

Funding

None.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding authors

Correspondence to Tetsuro Shimura or Masanori Yamamoto.

Ethics declarations

Conflict of interest

Dr. Yamamoto is a clinical proctor for Edwards Lifesciences, Medtronic, Abbott, and Boston Scientific. Dr. Yamamoto receives lecture fee from Edwards Lifesciences, Medtronic, Abbott, Boston Scientific, and Daiichi-Sankyo Company. Dr. Shimura receives lecture fee from Edwards Lifesciences, Medtronic, Boston Scientific, and Daiichi-Sankyo Company.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shimura, T., Yamamoto, M. & and on behalf of the OCEAN-SHD family. Transcatheter aortic valve implantation and frailty. Cardiovasc Interv and Ther 37, 626–634 (2022). https://doi.org/10.1007/s12928-022-00868-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-022-00868-w

Keywords

Navigation