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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Change in Frailty After Transcatheter and Surgical Aortic Valve Replacement for Aortic Stenosis-A Systematic Review
Hasan Mohiaddin1, Joseph Hayes2, Ravi Chotalia2
1NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK.
Background:
Frailty is common among patients awaiting intervention for aortic stenosis (AS) by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Although the association between pre-procedure frailty and poor outcomes is well-established, it remains unclear whether aortic valve interventions can lead to changes in frailty.
Methods:
Ovid MEDLINE, SCOPUS, CINAHL and Cochrane databases were searched for studies that reported frailty assessments before and after TAVI and/or SAVR. Data from these studies were used to calculate a standardised score for change in frailty following either TAVI or SAVR, as part of a pooled random effects meta-analysis, with Hedges' adjusted g value.
Results:
Of 4,093 records screened, nine relevant studies were identified. Among 1,598 TAVI and 200 SAVR patients, no overall changes to frailty were observed, although there was considerable heterogeneity among studies. Improvements to frailty were observed in a sensitivity analysis of lower-risk TAVI cohorts (Society of Thoracic Surgeons predicted risk of mortality [STS-PROM] ≤5%). Higher-risk TAVI and SAVR cohorts (STS-PROM >5%) did not show improvements in frailty post-aortic valve intervention.
Conclusions:
Overall, neither TAVI nor SAVR leads to significant changes in frailty measurements, although data are highly heterogeneous. Further research into the possible role of additional frailty interventions, particularly in higher-risk patients with AS undergoing TAVI or SAVR, should be considered.
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