Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Dec;97(51):e13475.
doi: 10.1097/MD.0000000000013475.

The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement: An update of systematic review and meta-analysis

LiLi Huang  1 , XiaoShuang Zhou  1 , XiaoYun Yang  2 , Hai Yu  1
Affiliations
Meta-Analysis

The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement: An update of systematic review and meta-analysis

LiLi Huang et al. Medicine (Baltimore). 2018 Dec.

Abstract

Background: Frailty is a syndrome of impaired physiologic reserve and decreased resistance to stressors and can often be seen in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Preoperative frailty status is thought to be related to adverse outcomes after TAVR. We conducted this systematic review and meta-analysis to determine the impact of preoperative frailty status on outcomes among patients after TAVR.

Methods: PubMed, Embase, and the Cochrane Library were searched for relevant studies through January 2018. Fourteen articles (n = 7489) meeting the inclusion criteria were finally included. Possible effects were calculated using meta-analysis.

Results: The pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney injury after TAVR in frail group were 2.81 (95% confidence interval (CI) 1.90-4.15, P < .001, I = 84%) and 1.41 (95% CI 1.02-1.94, P = .04, I = 24%), respectively. Compared with non-frail group, significantly higher incidence of 30-day mortality (RR 2.03, 95% CI 1.63-2.54, P < .001, I = 0%) and life threatening or major bleeding after TAVR (RR 1.48, 95% CI 1.20-1.82, P < .001, I = 14%) was found in frail group. There was no significant association between frailty and incidence of stroke after TAVR (RR 0.93, 95% CI 0.53-1.63, P = .80, I = 0%).

Conclusion: Preoperative frailty status is proved to be significantly associated with poor outcomes after TAVR. Our findings may remind doctors in the field of a more comprehensive preoperative evaluation for TAVR candidates. More well-designed and large-sample sized prospective studies are further needed to figure out the best frailty assessment tool for patients undergoing TAVR.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart. PRISMA flow diagram of study selection process.
Figure 2
Figure 2
Forest plot of included studies comparing the risk of AKI after TAVR in frail versus non-frail patients. Patients in frail group were significantly at higher risk of AKI after TAVR, compared with non-frail patients. Squares represent RR and horizontal lines represent the 95% CI for each study. A diamond data marker represents the pooled RR across studies. AKI = acute kidney injury, CI = confidence interval, RR = risk ratio, TAVR = transcatheter aortic valve replacement.
Figure 3
Figure 3
Forest plot of included studies comparing the risk of late mortality (>6 months) after TAVR in frail versus non-frail patients. Patients in frail group were significantly at higher risk of late mortality after TAVR, compared with non-frail patients. Squares represent RR and horizontal lines represent the 95% CI for each study. A diamond data marker represents the pooled RR across studies. CI = confidence interval, IV = inverse variance, RR = risk ratio, SE = standard error, TAVR = transcatheter aortic valve replacement.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Fried LP, Hadley EC, Walston JD, et al. From bedside to bench: research agenda for frailty. Sci Aging Knowledge Environ 2005;2005:e24. - PubMed
    1. Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017;69:1313–46. - PubMed
    1. Nishimura RA, Otto CM, Bonow RO, et al. 2017AHA/ACC focused update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017;70:252–89. - PubMed
    1. Kamga M, Boland B, Cornette P, et al. Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation. Acta Cardiol 2013;68:599–606. - PubMed
    1. Assmann P, Kievit P, van der Wulp K, et al. Frailty is associated with delirium and mortality after transcatheter aortic valve implantation. Open Heart 2016;3:e000478. - PMC - PubMed