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01-08-2021 | Aortic Valve Replacement | Original Article

Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement

Authors: Kodai Komaki, Naofumi Yoshida, Seimi Satomi-Kobayashi, Yasunori Tsuboi, Masato Ogawa, Kumiko Wakida, Takayoshi Toba, Hiroyuki Kawamori, Hiromasa Otake, Atsushi Omura, Katsuhiro Yamanaka, Takeshi Inoue, Tomoya Yamashita, Yoshitada Sakai, Kazuhiro P. Izawa, Kenji Okada, Ken-ichi Hirata

Published in: Heart and Vessels | Issue 8/2021

Abstract

Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.

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Title: Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement
Authors: Kodai Komaki
Naofumi Yoshida
Seimi Satomi-Kobayashi
Yasunori Tsuboi
Masato Ogawa
Kumiko Wakida
Takayoshi Toba
Hiroyuki Kawamori
Hiromasa Otake
Atsushi Omura
Katsuhiro Yamanaka
Takeshi Inoue
Tomoya Yamashita
Yoshitada Sakai
Kazuhiro P. Izawa
Kenji Okada
Ken-ichi Hirata
Publication date: 01-08-2021
Publisher: Springer Japan
Keywords: Aortic Valve Replacement
Aortic Valve Replacement
Aortic Valve Replacement
Published in: Heart and Vessels / Issue 8/2021
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-021-01793-3

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Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement

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