Transcatheter aortic valve implantation in the elderly: an umbrella review

Abstract

Aim: The management of aortic stenosis has seen momentous changes thanks to the introduction of transcatheter aortic valve implantation (TAVI, i.e., transcatheter aortic valve replacement). Indications to TAVI have expanded progressively to intermediate-and low-risk patients, but trends in life expectancy have led to an increase of elderly but fit individuals with aortic stenosis eligible for TAVI. Methods: We reviewed the current evidence base on TAVI in the elderly by conducting an umbrella review (i.e., overview of systematic reviews), based on a formal bibliographic search for systematic reviews on TAVI in elderly patients (≥ 65 years). Key, study, patient, procedural, and outcome data were extracted, and validity formally appraised with the Oxman-Guyatt index. Results: From 71 citations, eight reviews were included (totaling 39 studies and 8579 patients): five systematic reviews, and three meta-analyses. Topics of interest were cognitive function before and after TAVI, predictive role of muscle mass and frailty on post-TAVI outcomes, comparative safety and effectiveness of TAVI, and role of rehabilitation to improve patient outlook after TAVI. Thirty-three additional studies were retrieved by means of snowballing, emphasizing the

How Can We Best Measure Frailty in Cardiosurgical Patients?

“…Among cardiosurgical surgery patients in Germany, the percentage of the elderly is steadily increasing [1]. Therefore, more frail patients are seen in our daily practice, and it is our task as surgeons to evaluate the risk and benefit of an operation, as minimally invasive strategies or transcatheter approaches may be alternatives [2]. Various perioperative risk scores calculate perioperative risks, but cannot determine frailty, which leads to considerable heterogeneity in old patients [3][4][5][6].…”