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

Evidence to guide treatment for functionally dependent elderly patients with severe aortic stenosis is limited, making clinical decisions challenging.

The aim of this study was to evaluate the safety and outcomes of transcatheter aortic valve replacement (TAVR) in functionally dependent elderly patients. Japan's government-mandated Long-Term Care Insurance (LTCI) grades were used as an objective measure of frailty and social dependency.

We retrospectively analyzed consecutive patients with verified LTCI data undergoing TAVR at a single high-volume center between 2019 and 2023. Outcomes included all-cause and cardiovascular mortality, heart failure rehospitalization, NYHA functional class, and the VARC-3 (Valve Academic Research Consortium-3) unfavorable outcome.

A total of 649 patients with verified LTCI status were retrospectively analyzed. Of these, 101 (15.6%) and 179 (27.6%) were certified as requiring support and long-term care, respectively. Among the 3 groups, the long-term care group was older, more predominantly female, and exhibited higher levels of frailty, higher surgical risk, and more severe heart failure symptoms. Technical success exceeded 98% across all groups. Long-term care patients displayed a 2-fold higher risk of 2-year all-cause mortality (adjusted HR: 2.03; 95% CI: 1.35-3.09), whereas the support group had similar risk to the independent group (adjusted HR: 1.11; 95% CI: 0.62-1.98). Cardiovascular mortality and heart failure rehospitalization were similarly low across all strata. The VARC-3 unfavorable outcome occurred in 8.7%, 6.9%, and 14.0% of the independent, support, and long-term care groups, respectively (P = 0.096).

TAVR was technically safe and potentially provided benefit even in care-dependent elderly patients. Functional dependence alone should not preclude referral for TAVR.