Geriatric assessment in the prediction of delirium and long-term survival after transcatheter aortic valve implantation

Wulp, Kees van der; Wely, Marleen H. van; Schoon, Yvonne; Vart, Priya; Rikkert, Marcel G M Olde; Morshuis, Wim J.; Royen, Niels van; Gehlmann, Helmut; Garsse, Leen van; Kievit, Peter C.

doi:10.1016/j.jtcvs.2020.02.076

Cited by 18 publications

(25 citation statements)

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“…Los niveles de albúmina, la anemia y el test de 5 metros se correlacionan con mortalidad, estancia hospitalaria, sangrados y reingresos 25 . La limitación de movilidad también se ha relacionado con mayor incidencia de delirium tras el implante percutáneo de válvula aórtica (TAVI), y con mayor mortalidad a 2 años 26 . Emami et al 27 encontraron una prevalencia de desnutrición del 5% en una cohorte de más de 100.000 pacientes sometidos a TAVI, asociando mayor mortalidad, complicaciones y reingresos.…”

Section: Cardiopatía Estructuralunclassified

Selección de lo mejor del año 2020 en cardiología geriátrica

et al. 2021

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Section: Cardiopatía Estructuralunclassified

Selección de lo mejor del año 2020 en cardiología geriátrica

et al. 2021

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“…High-quality TAVR databases should enable us to produce risk models with performance comparable to surgical procedures or acute coronary syndrome. Incorporation of functional status/frailty assessment as important predictive factors may additionally improve model accuracy in the TAVR setting [34,35].…”

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confidence: 99%

Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients

et al. 2020

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Background Surgical risk prediction models are routinely used to guide decision-making for transcatheter aortic valve replacement (TAVR). New and updated TAVR-specific models have been developed to improve risk stratification; however, the best option remains unknown. Objective To perform a comparative validation study of six risk models for the prediction of 30-day mortality in TAVR Methods and results A total of 2946 patients undergoing transfemoral (TF, n = 2625) or transapical (TA, n = 321) TAVR from 2008 to 2018 from the German Rhine Transregio Aortic Diseases cohort were included. Six surgical and TAVR-specific risk scoring models (LogES I, ES II, STS PROM, FRANCE-2, OBSERVANT, GAVS-II) were evaluated for the prediction of 30-day mortality. Observed 30-day mortality was 3.7% (TF 3.2%; TA 7.5%), mean 30-day mortality risk prediction varied from 5.8 ± 5.0% (OBSERVANT) to 23.4 ± 15.9% (LogES I). Discrimination performance (ROC analysis, c-indices) ranged from 0.60 (OBSERVANT) to 0.67 (STS PROM), without significant differences between models, between TF or TA approach or over time. STS PROM discriminated numerically best in TF TAVR (c-index 0.66; range of c-indices 0.60 to 0.66); performance was very similar in TA TAVR (LogES I, ES II, FRANCE-2 and GAVS-II all with c-index 0.67). Regarding calibration, all risk scoring models-especially LogES I-overestimated mortality risk, especially in high-risk patients. Conclusions Surgical as well as TAVR-specific risk scoring models showed mediocre performance in prediction of 30-day mortality risk for TAVR in the German Rhine Transregio Aortic Diseases cohort. Development of new or updated risk models is necessary to improve risk stratification.

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“…4 To establish appropriate TAVR-specific risk models and predict early and late outcomes, several important articles have recently been published. [3][4][5][6][7] van der Wulp and colleagues 8 offer a carefully conducted study to identify geriatric assessment tools designed to predict postoperative delirium and long-term mortality after TAVR. These preoperative comprehensive assessment tools included the mini-mental state exam, basic and instrumental activities of daily living, gait speed and/or timed up and go test, and mini-nutritional assessment or serum albumin assessment.…”

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confidence: 99%

“…Along with other studies, 6,7 their results further confirmed that impaired preoperative mobility was among the strongest predictors of postoperative delirium and 1-to 2-year mortality in patients who underwent TAVR. 8,9 It remains unknown how many frailty indices should be incorporated into conventional risk scores to develop an ideal prognostic model with good discrimination and calibration. 4 Up to this point, the STS risk score (version 2.9) and STS/American College of Cardiology Transcatheter Valve Therapy Registry (version 2.1) have included 5-m gait speed in the patient-related factors.…”

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confidence: 99%

“…At the same time, it must have good discrimination and calibration power to reliably predict both short-and long-term outcomes. Greater implementation of easily measurable frailty indices such as mobility (gait speed and timed up and go test), the Clinical Frailty Scale, malnutrition (serum albumin level and body mass index), 10,11 sarcopenia (psoas muscle area determined by computed tomography scan), 12 cognitive impairment (mini-mental state exam), 8,9 anemia Incorporation of properly selected frailty indices into conventional risk models is required to improve early and late survival and reduce delirium episodes in geriatric patients who undergo TAVR.…”

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confidence: 99%

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