The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience.
The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience.
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DOI：
10.1016/j.jcin.2012.06.011
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发表时间：
2012-09
影响因子：
11.3
通讯作者：
Williams, Mathew
中科院分区：
文献类型：
--
作者：
Green, Philip;Woglom, Abigail E.;Genereux, Philippe;Daneault, Benoit;Paradis, Jean-Michel;Schnell, Susan;Hawkey, Marian;Maurer, Mathew S.;Kirtane, Ajay J.;Kodali, Susheel;Moses, Jeffrey W.;Leon, Martin B.;Smith, Craig R.;Williams, Mathew
本研究旨在评估老年患者在接受经导管主动脉瓣置换术(TAVR)治疗症状性主动脉瓣狭窄时虚弱的影响。虚弱状态影响老年心脏病患者的预后；然而，虚弱状态对TAVR术后预后的影响尚不清楚。在基线时收集步速、握力、血清白蛋白和日常生活活动能力，并用来计算在单一大容量机构接受TAVR手术的患者的脆弱评分。根据脆弱程度的中位数将队列分为虚弱组和非虚弱组。评估虚弱对手术结果(中风、出血、血管并发症、急性肾损伤和30天内死亡率)和1年死亡率的影响。对159名接受TAVR(年龄86±8岁，胸科手术协会风险评分12±4)的受试者进行了脆弱状态评估。基线脆弱评分与常规确定的临床变量或胸外科学会评分无关。尽管与脆弱程度较低的患者相比，脆弱程度高的患者术后住院时间较长(分别为9±6天和6±5天，p=0.004)，但脆弱状态和手术结果之间没有显著的粗略关联，这表明标准的筛选程序足以识别有可能发生TAVR术后围术期并发症的患者。脆弱状态与TAVR后1年死亡率的增加(风险比：3.595%可信区间：1.4至8.5p=0.007)独立相关。在选择接受TAVR的患者中，虚弱与围手术期并发症的增加无关，但与TAVR后1年死亡率的增加有关。进一步的研究将评估这种脆弱的复合体在患有主动脉狭窄的老年人中的独立价值。
This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for symptomatic aortic stenosis. Frailty status impacts prognosis in older adults with heart disease; however, the impact of frailty on prognosis after TAVR is unknown. Gait speed, grip strength, serum albumin, and activities of daily living status were collected at baseline and used to derive a frailty score among patients who underwent TAVR procedures at a single large-volume institution. The cohort was dichotomized on the basis of median frailty score into frail and not frail groups. The impact of frailty on procedural outcomes (stroke, bleeding, vascular complications, acute kidney injury, and mortality at 30 days) and 1-year mortality was evaluated. Frailty status was assessed in 159 subjects who underwent TAVR (age 86 ± 8 years, Society of Thoracic Surgery Risk Score 12 ± 4). Baseline frailty score was not associated with conventionally ascertained clinical variables or Society of Thoracic Surgery score. Although high frailty score was associated with a longer post-TAVR hospital stay when compared with lower frailty score (9 ± 6 days vs. 6 ± 5 days, respectively, p = 0.004), there were no significant crude associations between frailty status and procedural outcomes, suggesting adequacy of the standard selection process for identifying patients at risk for periprocedural complications after TAVR. Frailty status was independently associated with increased 1-year mortality (hazard ratio: 3.5, 95% confidence interval: 1.4 to 8.5, p = 0.007) after TAVR. Frailty was not associated with increased periprocedural complications in patients selected as candidates to undergo TAVR but was associated with increased 1-year mortality after TAVR. Further studies will evaluate the independent value of this frailty composite in older adults with aortic stenosis.
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影响因子：
4.6
作者：
Shroyer, ALW;Coombs, LP;Edwards, FH
通讯作者：
Edwards, FH
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
Salamon, R
影响因子：
2.7
作者：
Harrington, Mary Beth;Kraft, Malissa;Rudolph, James L.
通讯作者：
Rudolph, James L.
影响因子：
4.8
作者：
Ewe, See Hooi;Marsan, Nina Ajmone;Bax, Jeroen J.
通讯作者：
Bax, Jeroen J.
DOI：
10.1111/j.1532-5415.2006.00914.x
发表时间：
2006-11-01
影响因子：
6.3
作者：
Purser, Jama L.;Kuchibhatla, Maragatha N.;Alexander, Karen P.
通讯作者：
Alexander, Karen P.