Evaluation of Changes in Functional Status in the Year After Aortic Valve Replacement

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Quality of Life Research

Background:

• Functional status is a key patient-centered outcome after aortic valve replacement (AVR).
• Understanding functional trajectories post-AVR is crucial for improving health-related quality of life.
• Severe aortic stenosis necessitates AVR, with both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) as viable options.

Purpose of the Study:

• To determine functional status trajectories in the year following TAVR and SAVR.
• To investigate the association between preoperative frailty and functional outcomes after AVR.
• To identify factors influencing functional decline or improvement post-procedure.

Main Methods:

• A prospective cohort study involving 246 patients with severe aortic stenosis undergoing either TAVR or SAVR.
• Comprehensive geriatric assessment and frailty index (CGA-FI) calculation preoperatively.
• Self-reported functional status assessed via telephone interviews at 1, 3, 6, 9, and 12 months post-procedure.

Main Results:

• Five distinct functional status trajectories were identified, ranging from excellent baseline to very poor.
• The 'fair' trajectory was most common after TAVR (37.8%), while 'good' was most common after SAVR (37.9%).
• Higher preoperative frailty (CGA-FI) was associated with lower functional improvement and greater decline. Postoperative delirium and major complications correlated with poorer functional outcomes.

Conclusions:

• Functional decline or lack of improvement is prevalent in frail older adults undergoing TAVR or SAVR.
• Preoperative frailty is a significant predictor of functional trajectories post-AVR.
• Anticipated functional trajectories can inform patient-centered decision-making and perioperative care strategies.