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Predictive Value for Outcome and Evolution of Geriatric Parameters after Transcatheter Aortic Valve Implantation

F Roca1, E Durand, H Eltchaninoff

  • 1Dr Roca Frédéric, Service de Médecine Gériatrique, CHU de Rouen, 76031 Rouen Cedex, France. Tel: +33 2 32 88 93 67, Fax: +33 2 32 88 06 01;

The Journal of Nutrition, Health & Aging
|June 9, 2020
PubMed

Insights

Comprehensive geriatric assessment (CGA) identifies poor outcomes after TAVI. Most CGA parameters remain stable at 6 months, but cognitive function evolves based on prior status.

Area of Science:

  • Geriatric Medicine
  • Cardiology
  • Transcatheter Aortic Valve Implantation (TAVI)

Background:

  • Transcatheter Aortic Valve Implantation (TAVI) is a crucial procedure for elderly patients with aortic stenosis.
  • Assessing frailty and geriatric parameters is vital for predicting outcomes in this population.
  • Comprehensive Geriatric Assessment (CGA) offers a multidomain evaluation of older adults' health status.

Purpose of the Study:

  • To identify Comprehensive Geriatric Assessment (CGA) parameters, including the ABCDEF score, associated with adverse outcomes following TAVI.
  • To evaluate the changes in CGA parameters at a 6-month follow-up after TAVI.

Main Methods:

  • A prospective, monocentric cohort study involving 114 patients over 70 years old selected for TAVI.
  • 8-area CGA was performed pre-TAVI and at 6-month follow-up.
  • Poor outcome was defined as a decline in basic activities of daily living (BADL), unplanned readmission, or all-cause mortality within one year.

Main Results:

  • 50% of patients experienced poor outcomes.
  • Independent predictors of poor outcome included loss of one BADL, decreased instrumental activities of daily living (IADL), lower plasmatic albumin, reduced Mini-Mental State Examination (MMSE) scores, slower walking speed, and an ABCDEF score of 2 or higher.
  • At 6 months, most geriatric parameters were stable in survivors, except for a significant decrease in IADL. The MMSE showed improvement in those with prior cognitive impairment but decline in others.

Conclusions:

  • Comprehensive Geriatric Assessment (CGA) parameters are significant independent predictors of poor outcomes post-TAVI.
  • While most CGA parameters remain stable at 6 months, IADL shows a decline, and the trajectory of cognitive function (MMSE) is influenced by baseline cognitive status.
Abstract

Keywords:
Aortic stenosiscomprehensive geriatric assessmentfrailtytranscatheter aortic valve replacement

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