Clinical impact of transcatheter aortic valve implantation (TAVI) in frail patients: a single-center prospective study
Authors: Martinez Lopez D , Herrero-Brocal M , Yago Riquelme C , Fuertes Kenneally L , Garcia Barrios A , Lopez-Menchero Ortiz De Salazar C , Lloret Rubio A , Mateo Soler J M , De La Hoz Maranon L , Alcala Belmonte M , Vidal Planelles I , Lopez Clemente J C , Lozano Palencia T , Torres Mezcua F , Ruiz-Nodar J M 
Published: October 2024

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) stands as an effective treatment option for symptomatic severe aortic stenosis, applicable across all surgical risk spectrum. Registries show that up to 60% of these patients exhibit at least one marker of frailty. Frailty has been associated with higher 1-year mortality rates and heightened susceptibility to complications. Conservative treatment, however, has a poor prognosis, with mortality ranging from 30-60% within a year after diagnosis.

Objective
The primary objective was to assess the clinical impact of TAVI implantation in the frail population. A secondary objective was to assess the occurrence of in-hospital and short-term (30 days) complications.

Methods
Observational, prospective, single-center study that included all patients with TAVI implantation in our unit in 2023. Frailty was assessed by an interventional cardiologist according to the Rockwood Clinical Frailty Scale (CFS) or Frailty Scale, assigning a score from 1 to 9, with patients being classified as high CFS if they scored ≥5 points or low CFS if &lt;5 points.

Results
Out of the 298 patients included, 45 (15%) had high CFS vs 253 (85%) with low CFS. Significant differences were found in age (83.3±5.3 years for high CFS vs 79.4±5.8 years for low CFS;p&lt;0.01), gender (60% of females for high CFS vs 43.9% for low CFS;p=0.046) and baseline haemoglobin (12.2±1.5 g/dL for high CFS vs 12.9±1.8 g/dL for low CFS;p=0.008). Other baseline characteristics remained comparable. Patients with high CFS had greater baseline dyspnoea according to the YHA scale (NYHA III-IV 71.1% for high CFS vs 37.9% for low CFS;p&lt;0.001) with greater diuretic use (71.1% for high CFS vs 51% for low CFS;p=0.013).
Patients with high CFS had a greater need for a preferential/urgent procedure (p=0.044). There were no differences in the occurrence of complications: stroke (p=0.463), bleeding (p=0.667), vascular complications (p=0.234); except for a higher occurrence of complete AV block (22.3% for high CFS vs 8.7% for low CFS;p=0.024). In-hospital mortality rates showed no differences (0% for high CFS vs 1.6% for low CFS;p=0.396).
At 1-month follow-up, there was a significant reduction in NYHA dyspnoea grade within the high CFS group (71.1% NYHA III-IV pre-TAVI vs 2.3% post-TAVI; p&lt;0.001). There was no difference in the incidence of stroke (p=0.375), heart failure readmissions (p=0.734), and vascular complications (p=0.66). There was no difference in all-cause mortality (4.4% for high CFS vs 3.2% for low CFS;p=0.675).

Conclusions
Highly frail patients undergoing TAVI experience a significant enhancement in functional class compared to their less frail counterparts. While short-term complications parallel those observed in less frail individuals, there is a slightly elevated incidence of pacemaker requirements in this group.NYHA Frail pre and post TAVIComplications