Surgical aortic valve replacement in elderly patients: effects on physical performance, cognitive function and health-related quality of life

Rui, Marina De; Tarzia, Vincenzo; Mazzochin, Mattia; Bertocco, Anna; Ceolin, Chiara; Trevisan, Caterina; Tessari, Chiara; Cavalli, Chiara; Piperata, Antonio; Coin, Alessandra; Gerosa, Gino; Sergi, Giuseppe

doi:10.1007/s40520-021-01969-x

Cited by 3 publications

(3 citation statements)

References 35 publications

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“…Limited data exist for cognitive function changes occurring after SAVR. De Rui et al (7) showed a significant worsening of the patients' condition in the MoCA test performed 1 year after SAVR; however, this finding is not confirmed in our series. Basically, our data support the concept that the removal of aortic valve obstruction is beneficial in neurocognitive terms, regardless of the procedure.…”

Section: Discussioncontrasting

confidence: 97%

“…One certain factor is that elderly (>70 years) patients referred to AS procedures have a pre-procedural impairment of neurocognitive function. When tested with a Montreal Cognitive Assessment (MoCA), 70% of the patients have a MoCA score <26, which is considered the cutoff value for normal cognitive function (7). This pattern finds different causative factors such as comorbidities, previous neurological events, dementia, and other neurological diseases; however, inadequate cerebral blood flow may be a contributor, especially in elderly subjects (8).…”

Section: Introductionmentioning

confidence: 99%

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Neurocognitive function in procedures correcting severe aortic valve stenosis: patterns and determinants

Ranucci,

Brischigiaro,

Mazzotta

et al. 2024

Front. Cardiovasc. Med.

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BackgroundNeurocognitive changes occurring after a surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) procedure for the correction of severe aortic stenosis (AS) have not been widely addressed and, if addressed, have produced conflicting results. The purpose of this study is to identify the pre-procedural neurocognitive pattern and its determinants in a setting of elderly (>65 years) patients with severe AS undergoing SAVR or TAVI and the changes occurring at a 2–3 month follow-up.MethodsThis was a prospective cohort study included in the Italian Registry on Outcomes in Aortic Stenosis Treatment in Elderly Patients. Patients were assessed both before and after (2–3 months) the procedure using the Montreal Cognitive Assessment (MoCA) test. Data on periprocedural demographics, clinical factors, and outcome measures were collected.ResultsBefore the procedure, 70% of the patients demonstrated a MoCA score <23 points, which was indicative of cognitive dysfunction. The factors associated with neurocognitive dysfunction were age, functional capacity, chronic heart failure, and hemoglobin levels. After the procedure, there was an overall improvement in the MoCA score of the patients, but 28% of the patients showed a reliable worsening of their condition. The factors associated with MoCA worsening were platelet transfusions and the amount of red blood cell units transfused.ConclusionThe correction of severe AS leads to an improvement in neurocognitive function after 2–3 months. This improvement does not differentiate between SAVR and TAVI after matching for pre-procedural factors. The only modifiable factor associated with pre-procedural neurocognitive function is anemia, and anemia correction with red blood cell transfusions is associated with a worsening of neurocognitive function. This leads to the hypothesis that anemia correction before the procedure (with iron and/or erythropoietin) may limit the risk of a post-procedural worsening of neurocognitive function.

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Section: Discussioncontrasting

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Neurocognitive function in procedures correcting severe aortic valve stenosis: patterns and determinants

Ranucci,

Brischigiaro,

Mazzotta

et al. 2024

Front. Cardiovasc. Med.

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“…Over time, with the improvement of the surgical procedure, the risks for such procedure have decreased and survival and quality of life of patients have accordingly improved. [ 6 ] Various techniques employed to replace aortic valve include the use of bioprosthetic valve sourced from using animal valve or pericardium, the use of mechanical valve made by tolerable synthetic materials for the body such as metal and carbon, pulmonary autograft (removing the aortic valve and replacing with patient's own pulmonary valve) and prosthetic valve replacement by TAVR. [ 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

Comparing clinical and hemodynamic parameters between the two aortic valve replacement in patients with severe aortic stenosis

Moaref

Zarrabi

Hassanzadeh

et al. 2022

J Cardiovasc Echography

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Context: Various techniques have been proposed for suturing following prosthetic aortic valve implantation, but each has its potential side effects such as patient-prosthesis mismatch (PPM) and paravalvular leak (PVL). Aims: In the present study, we aimed to compare the postoperative sequels of aortic valve replacement (AVR) following the use of two suturing techniques including from the inside of the aorta as the common and classic suturing techniques as compared to new approach including from the outside of the aorta. Settings and Design: This cross-sectional study was performed on patients suffering from symptomatic severe aortic valve disease and candidates for AVR in one of three referral hospitals for cardiovascular disease patients in Shiraz from 2019–2021. Subjects and Methods: The patients underwent one of the two considered surgical techniques for AVR including traditional approach ( n = 60) or the tested approach (suturing from the outside of the aorta) ( n = 30). Statistical Analysis Used: For statistical analysis, results were presented as mean ± standard deviation for quantitative variables and were summarized by frequency (percentage) for categorical variables. Results: PVL and PPM were revealed in none of the participants undergoing the tested approach, while the pointed complications were found in 41.7% and 25.0% of patients underwent traditional approach, respectively, indicating a significant difference. There was no evidence of abnormal dimensionless valve index (DVI) in the patients undergoing sutures from outside the aorta, whereas the rate of DVI abnormality in the patients undergoing traditional procedures was shown to be 18.3%. The mean aortic valve gradient was significantly higher in the group scheduling for the traditional surgical method. Conclusions: Applying new suturing method as suturing from the outside of the aorta, due to the selection of appropriate valve size, the risk for adverse consequences including PPM, PVL, or DVI can be significantly reduced.

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Quality of Life Measures in Aortic Stenosis Research: A Narrative Review

Frank¹,

Kennon²,

Bonaros³

et al. 2023

Cardiology

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Background: Elderly patients with aortic stenosis (AS) not only have a reduced life expectancy but also a reduced quality of life (QoL). The benefits of an AS intervention may be considered a balance between a good QoL and a reasonably extended life. However, the different questionnaires being used to determine the QoL, were generally not developed for the specific situation of patients with AS and come with strengths and considerable weaknesses. The objective of this manuscript was to provide an overview of the available QoL instruments in AS research, describe their strengths and weaknesses, and to provide our assessment of the utility of the available scoring instruments for QoL measurements in AS. Summary: We identified and reviewed the following instruments that are used in AS research: Short Form Health Survey (SF-36/SF-12), EuroQol-5D (EQ-5D), the Illness Intrusiveness Rating Scale (IIRS), the HeartQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHF), the MacNew Questionnaire, and the Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ). Key messages: There is no standardized assessment of QoL in patients with AS. Many different questionaires are being used, but they are rarely specific for AS. There is a need for AS specific research into the QoL of patients as life prolongation may compete for an improved QoL in this elderly patient group.

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Surgical aortic valve replacement in elderly patients: effects on physical performance, cognitive function and health-related quality of life

Cited by 3 publications

References 35 publications

Neurocognitive function in procedures correcting severe aortic valve stenosis: patterns and determinants

Neurocognitive function in procedures correcting severe aortic valve stenosis: patterns and determinants

Comparing clinical and hemodynamic parameters between the two aortic valve replacement in patients with severe aortic stenosis

Quality of Life Measures in Aortic Stenosis Research: A Narrative Review

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