Transcatheter Aortic Valve Implantation in Elderly Patients With Aortic Valve Stenosis: The Role of Frailty, Malnutrition, and Sarcopenia

Sá, Michel Pompeu Barros de Oliveira; Erten, Ozgun; Ramlawi, Basel

doi:10.1161/jaha.122.027705

Cited by 9 publications

(11 citation statements)

References 20 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering that the feasibility and immediate safety of TAVR are well reported in RCTs, 13 , 15 , 16 the fast development and broader indication of TAVR in younger and lower‐risk patients have led to closer attention to longer follow‐ups beyond the immediate postprocedural period. 20 Although immediate and short‐term outcomes such as shorter length of hospital stay and lower rates of readmission in the first months is a proof of the better outcomes of TAVR within the first months due to the less invasive nature of this procedure, 21 later outcomes such as valve thrombosis, structural valve deterioration, and coronary events may alter the initial early survival benefit of TAVR.…”

Section: Discussionmentioning

confidence: 99%

Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data

Sá,

Jacquemyn,

Van den Eynde

et al. 2023

JAHA

Self Cite

View full text Add to dashboard Cite

Background We performed a meta‐analysis of reconstructed time‐to‐event data from randomized controlled trials (RCTs) and propensity‐score matched (PSM) studies comparing transcatheter versus surgical aortic valve replacement (TAVR versus SAVR) to evaluate midterm outcomes in patients considered low risk for SAVR. Methods and Results Study‐level meta‐analysis of reconstructed time‐to‐event data from Kaplan–Meier curves of RCTs and PSM studies published by December 31, 2022 was conducted. Eight studies (3 RCTs, 5 PSM studies) met our eligibility criteria and included 5444 patients; 2639 patients underwent TAVR, and 2805 patients underwent SAVR. TAVR showed a higher risk of all‐cause mortality at 8 years of follow‐up (hazard ratio [HR] 1.22, [95% CI, 1.03–1.43], P =0.018). Up to 2 years of follow‐up, TAVR was not inferior to SAVR (HR, 1.08 [95% CI, 0.89–1.31], P =0.448); however, we observed a statistically significant difference after 2 years with higher mortality with TAVR (HR, 1.51 [95% CI, 1.14–2.00]; P =0.004). This difference was driven by PSM studies; our sensitivity analysis showed a statistically significant difference between TAVR and SAVR when we included only PSM studies (HR, 1.41 [95% CI, 1.16–1.72], P =0.001) but no statistically significant difference when we included only RCTs (HR, 0.89 [95% CI, 0.69–1.16], P =0.398). Conclusions In comparison with TAVR, SAVR appeared to be associated with improved survival beyond 2 years in low‐risk patients. However, the survival benefit of SAVR was observed only in PSM studies and not in RCTs. The addition of data from ongoing RCTs as well as longer follow‐up in previous RCTs will help to confirm if there is a difference in mid‐ and long‐term survival between TAVR versus SAVR in the low‐risk population.

show abstract

Section: Discussionmentioning

confidence: 99%

Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data

Sá,

Jacquemyn,

Van den Eynde

et al. 2023

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…The study population is relatively elderly, with a mean age of 83.9 years. This finding may influence the observed outcomes considering the potential role of frailty, malnutrition, and sarcopenia ( 27 ). However, almost all study participants benefited from geriatric assessment before undergoing the procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital outcomes and long-term survival for valve-in-valve transcatheter aortic valve replacement versus the benchmark native valve transcatheter aortic valve replacement procedure

Matta

Lévai²,

Roncalli³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundIn recent years, the number of patients with failed surgically implanted aortic bioprostheses and the number of candidates for valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) have been increasing.ObjectivesThe purpose of this study is to evaluate the efficacy, safety, and long-term survival outcomes of VIV-TAVR compared with the benchmark native valve transcatheter aortic valve replacement (NV-TAVR).MethodsA cohort study was conducted on patients who underwent TAVR in the department of cardiology at Toulouse University Hospital, Rangueil, France between January 2016 and January 2020. The study population was divided into two groups: NV-TAVR (N = 1589) and VIV-TAVR (N = 69). Baseline characteristics, procedural data, in-hospital outcomes, and long-term survival outcomes were observed.ResultsIn comparison with NV-TAVR, there are no differences in TAVR success rate (98.6 vs. 98.8%, p = 1), per-TAVR complications (p = 0.473), and length of hospital stay (7.5 ± 50.7 vs. 4.4 ± 2.8, p = 0.612). The prevalence of in-hospital adverse outcomes did not differ among study groups, including acute heart failure (1.4 vs. 1.1%), acute kidney injury (2.6, 1.4%), stroke (0 vs. 1.8%, p = 0.630), vascular complications (p = 0.307), bleeding events (0.617), and death (1.4 vs. 2.6%). VIV-TAVR was associated with a higher residual aortic gradient [OR = 1.139, 95%CI (1.097–1.182), p = 0.001] and a lower requirement for permanent pacemaker implantation [OR = 0.235 95%CI (0.056–0.990), p = 0.048]. Over a mean follow-up period of 3.44 ± 1.67 years, no significant difference in survival outcomes has been observed (p = 0.074).ConclusionVIV-TAVR shares the safety and efficacy profile of NV-TAVR. It also represents a better early outcome but a higher non-significant long-term mortality rate.

show abstract

“…Initially, several scores were developed related to malnutrition, which was associated with poor clinical outcomes in cancer patients 8,15,16 . Additionally, malnutrition has also been associated with mortality, morbidity, and disease severity in cardiovascular disease 6,10,13,14,17–21 . Recently, several investigators have reported that malnutrition is a predictor of worse outcomes in patients with severe AS undergoing surgical aortic valve replacement 14,22 .…”

Section: Discussionmentioning

confidence: 99%

“…Although malnutrition has been investigated with increasing interest in recent years, it is one of the hallmarks of frailty. 6,8,9,13,14 Initially, several scores were developed related to malnutrition, which was associated with poor clinical outcomes in cancer patients. 8,15,16 Additionally, malnutrition has also been associated with mortality, morbidity, and disease severity in cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…8,15,16 Additionally, malnutrition has also been associated with mortality, morbidity, and disease severity in cardiovascular disease. 6,10,13,14,[17][18][19][20][21] Recently, several investigators have reported that malnutrition is a predictor of worse outcomes in patients with severe AS undergoing surgical aortic valve replacement. 14,22 Likewise, Sudo et al have recently shown that patients with low nutritional status were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

Demirci,

Aslan,

Güner

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

BackgroundOne of the hallmarks of frailty in patients with severe aortic stenosis (AS) is malnutrition, for which one of the most up‐to‐date scoring systems is the Naples prognostic score (NPS). This study sought to investigate the predictive role of the NPS in determining mortality in patients undergoing transcatheter aortic valve replacement (TAVR) under long‐term follow‐up.MethodsA total of 430 consecutive patients with symptomatic severe AS who underwent TAVR were included retrospectively. The primary endpoint of the study was the long‐term all‐cause mortality. The study population was divided into two groups according to the NPS value, including Group 1 (NPS 0–2) and Group 2 (NPS 3–4).ResultsThe all‐cause mortality occurred in 250 patients (62.5%) patients during a follow‐up time of 40.6 (22.0–69.4) months. During the follow‐up period, all‐cause mortality was higher in Group 2 compared with Group 1 (87.9% vs. 42.9%, p < 0.001). Older age (p < 0.001), chronic obstructive pulmonary disease (p = 0.015), left ventricular ejection fraction (p = 0.021), and being in Group 2 (high NPS) (hazard ratio: 7.058, 95% confidence interval: 5.174–9.629, p < 0.001) were found to be independent predictors of all‐cause mortality at long‐term follow‐up.ConclusionThe NPS as a malnutrition and inflammation marker in patients with severe aortic stenosis who underwent TAVR provides valuable information for all‐cause mortality under long‐term follow‐up.

show abstract

Transcatheter Aortic Valve Implantation in Elderly Patients With Aortic Valve Stenosis: The Role of Frailty, Malnutrition, and Sarcopenia

Cited by 9 publications

References 20 publications

Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data

Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data

Comparison of in-hospital outcomes and long-term survival for valve-in-valve transcatheter aortic valve replacement versus the benchmark native valve transcatheter aortic valve replacement procedure

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

Contact Info

Product

Resources

About