Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement

• Published in: Heart and vessels Vol. 36; no. 8; pp. 1234 - 1245
• Main Authors: Komaki, Kodai, Yoshida, Naofumi, Satomi-Kobayashi, Seimi, Tsuboi, Yasunori, Ogawa, Masato, Wakida, Kumiko, Toba, Takayoshi, Kawamori, Hiroyuki, Otake, Hiromasa, Omura, Atsushi, Yamanaka, Katsuhiro, Inoue, Takeshi, Yamashita, Tomoya, Sakai, Yoshitada, Izawa, Kazuhiro P., Okada, Kenji, Hirata, Ken-ichi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.08.2021; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Complications; Exercise Tolerance; Frailty; Frailty - complications; Frailty - diagnosis; Heart Valve Prosthesis Implantation; Heart valves; Humans; Medicine; Medicine & Public Health; Original; Original Article; Patient Discharge; Postoperative Complications - epidemiology; Recovery of function; Retrospective Studies; Stenosis; Therapeutic applications; Transcatheter Aortic Valve Replacement - adverse effects; Vascular Surgery; Aortic stenosis; Frailty; Surgical aortic valve replacement; Exercise capacity; Transcatheter aortic valve replacement
• ISSN: 0910-8327; 1615-2573; 1615-2573
• DOI: 10.1007/s00380-021-01793-3

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.