Frailty Common on Older Patients Despite TAVR/SAVR Benefits

Declining function and difficultly improving conditions is common among very elderly patients who underwent transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) a new analysis suggests.

Researchers for the paper, publishing in JAMA Internal Medicine, sought to look at function status trajectories in the year following the cohort study included 246 patients undergoing TAVR (n-143) or SAVR (n=103) for severe aortic stenosis. A preoperative assessment was performed, and patients were categorized by deficit-accumulation fragility index (CGA-FI; ranges from 0 to 1, where higher values indicate greater fragility).

Clinical trajectories were developed: excellent, good, fair, poor, and very poor. According to the results, the most common trajectory following TAVR was fair, followed by good, then poor, then excellent, then very poor. For SAVR, the most common trajectory was good, then excellent, then fair, then poor, and finally very poor. Patients with low preoperative CGA-FI levels had either excellent or good trajectories compared to fair trajectories in patients with higher CGA-FI levels.

“The findings suggest that functional decline or lack of improvement is common in older adults with severe frailty undergoing TAVR or SAVR,” the authors wrote. “Although this nonrandomized study does not allow comparison of the effectiveness between TAVR and SAVR, anticipated functional trajectories may inform patient-centered decision making and perioperative care to optimize functional outcomes.”

Source: JAMA Internal Medicine