Futility, benefit, and transcatheter aortic valve replacement

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Geriatric Medicine

Background:

• Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis in high-risk patients.
• While TAVR improves survival and symptoms for many, a subset experiences poor outcomes or lack of improvement.
• This highlights the challenge of identifying futility in TAVR candidates.

Purpose of the Study:

• To review factors beyond traditional risk stratification for assessing TAVR benefit in elderly patients.
• To emphasize the role of multidisciplinary heart valve teams in complex TAVR decision-making.
• To discuss communication strategies regarding TAVR outcomes and potential futility.

Main Methods:

• Review of current literature and clinical considerations for TAVR in elderly, high-risk populations.
• Emphasis on comprehensive patient assessment including multimorbidity, frailty, and cognitive status.
• Discussion of multidisciplinary team approach and patient-provider communication.

Main Results:

• Traditional risk scores may not fully capture TAVR benefit in the very elderly.
• Factors like frailty, comorbidities, and cognition significantly influence TAVR outcomes.
• Multidisciplinary evaluation and clear communication are essential for appropriate TAVR selection.

Conclusions:

• Identifying potential TAVR futility requires a holistic patient assessment.
• Multidisciplinary heart valve teams are critical for optimizing TAVR decision-making.
• Discussions should include alternative care plans and end-of-life considerations when TAVR is deemed futile.