Transcatheter Aortic Valve Replacement in Functionally Dependent Patients: Analysis Using a Government-Adjudicated...

Area of Science:

• Cardiology
• Interventional Cardiology
• Geriatric Medicine

Background:

• Limited evidence exists for treating elderly patients with severe aortic stenosis who are functionally dependent.
• Clinical decisions for this population are challenging due to frailty and social dependency.

Purpose of the Study:

• To assess the safety and outcomes of transcatheter aortic valve replacement (TAVR) in functionally dependent elderly patients.
• To utilize Japan's Long-Term Care Insurance (LTCI) grades as an objective frailty measure.

Main Methods:

• Retrospective analysis of 649 patients with verified LTCI data undergoing TAVR (2019-2023).
• Outcomes included mortality, heart failure rehospitalization, NYHA class, and VARC-3 unfavorable outcomes.
• Patients were stratified into independent, support, and long-term care groups based on LTCI grades.

Main Results:

• Technical TAVR success exceeded 98% across all groups.
• The long-term care group showed a 2-fold higher risk of 2-year all-cause mortality (aHR: 2.03).
• Cardiovascular mortality and heart failure rehospitalization rates were low across all groups, with VARC-3 unfavorable outcomes at 8.7%, 6.9%, and 14.0% for independent, support, and long-term care groups, respectively.

Conclusions:

• TAVR is technically safe and potentially beneficial for care-dependent elderly patients with severe aortic stenosis.
• Functional dependence should not be a barrier to TAVR referral.