Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement

Abstract

Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively ( p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.

Inspiratory Muscle and Functional Performance of Patients Entering Cardiac Rehabilitation after Cardiac Valve Replacement

“…A key finding was that frailty status did not impact 6MWT performance following surgery. They found that the SAVR group, regardless of frailty, declined significantly, whereas the TAVR group's 6MWT decline did not reach statistical significance [20]. These results suggest that our subjects possibly had higher pre-operative measures as well.…”

Influence of preoperative frailty on quality of life after cardiac surgery: A systematic review and meta‐analysis

“…The first study found a lower likelihood of discharge to a home location for patients with preoperative frailty, independent of the tool used (CHS vs. Study of Osteoporotic Fractures [SOF]) 14 . The second study also found frailty to be associated with a non‐home discharge location, with an adjusted OR of 0.1 (0.06–0.29) 22 . The third study did not find a statistically significant association, and reported an OR of 0.8 (0.3–1.8) 18 .…”

“…Patients were enrolled between 2007 and 2019. Seven studies were performed in North America, 13–19 two in Europe, 20,21 and one in Asia 22 . All studies were cohort studies, seven being prospective 13–15,17,19–21 and three being retrospective 16,18,22 .…”

“…Three studies evaluated the impact of patient frailty on discharge to LTC or nursing facility, 13,20,21 all with a statistically significant association, with ORs between 2.6 and 3.1. Three studies evaluated the impact of baseline frailty on discharge to a home location 14,18,22 . The first study found a lower likelihood of discharge to a home location for patients with preoperative frailty, independent of the tool used (CHS vs. Study of Osteoporotic Fractures [SOF]) 14 .…”

“…Seven studies were performed in North America, [13][14][15][16][17][18][19] two in Europe, 20,21 and one in Asia. 22 All studies were cohort studies, seven being prospective [13][14][15]17,[19][20][21] and three being retrospective. 16,18,22 There was important variability in the tools used to assess frailty, with six different tools being employed amongst the 10 included studies.…”