Surgical versus Transvalvular Aortic Valve Replacement in Elderly Patients—The Impact of Frailty

Abstract

(1) Background: The aging process leads to an increased number of patients with cardiovascular diseases that require surgical treatment. One of the most common heart diseases with an increased prevalence in the elderly is aortic stenosis (AS). Recently, transcatheter aortic valve implantation (TAVI) has become the preferred technique for frail patients with high surgical risk. Currently, there is no gold standard method for assessing frailty. The available scores are objective, but limited by the lack of prospective information, especially from patients undergoing cardiac surgery or interventional procedures. Moreover, the current frailty scores record only certain aspects of the frailty identified in some system and organs. The aims of this study were to evaluate the different profile patients treated with TAVI or with surgical aortic valve replacement (SAVR) and to analyze the risk factors of unfavorable outcomes in the two groups to identify potential factors for frailty that could be included in the new scoring system. (2) Methods: This study included patients over 65 years old evaluated with severe, symptomatic AS treated with TAVI or SAVR admitted to the Cardiovascular Diseases Institute, Iasi. (3) Results: The group included 88 patients treated with TAVI compared with 218 patients undergoing SAVR. Most of the TAVI patients (84.09%) were over 70 years compared to 30.09% of the SAVR group. The TAVI patients had an increased surgical risk assessed by EuroSCORE II (15 vs. 4%) and severe heart failure (NYHA IV, 36.36 vs. 6.48%). The only residual symptom was dyspnea, in a significantly lower prevalence compared to preoperative evaluation. (4) Conclusions: TAVI improves the general status with results comparable to SAVR in elderly patients with increased severity of the disease and higher prevalence of comorbidities.

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“…GPT-4 provided an incorrect answer, suggesting surgical replacement of the aortic valve rather than the correct percutaneous aortic valve implantation (TAVI). The error stems from a misinterpretation of the clinical context provided, where a patient with intermediate surgical risk and elevated creatinine levels would be better suited for a less invasive procedure like TAVI [98,99]. This misjudgment could have been due to an oversight in assessing all patient risk factors, including age, symptoms, and renal function, which are pivotal in determining the most appropriate therapeutic approach.…”