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Transcatheter aortic valve replacement (TAVR) has become a more utilized procedure to perform on patients deemed too frail to handle the demands of surgical aortic valve replacement (SAVR). Assessing frailty in TAVR candidates remains challenging to objectively quantify without a standardized approach or measure. TVT registry requires baseline and 30 day postoperative assessment using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), however this is a “general health” tool. One potential as a gold standard is using the five domains of frailty based on Fried’s frailty phenotype (Fried scale), of which a minimum of three domains met deem someone as frail. The aim of this research was to 1)statistically measure which outcome tool most accurately depicted frailty in patients with severe aortic stenosis who underwent TAVR and 2) determine which frailty composite of Fried’s three domains best predicts procedural complications in the TAVR population.
Prior to TAVR, all patients underwent a frailty assessment whereby physical activity and exhaustion scales were administered as well as 5-m gait speed, weight loss amount and grip strength were obtained to derive baseline Fried frailty scores (out of 5) as well as the KCCQ-12 (for KCCQ Summary Score). The cohort was dichotomized according to frail/not frail with ≥ 3 criteria met as frail for Fried scale and <60 deemed frail for KCCQ-12 Summary Score, then compared to procedural complications and 30-day mortality. Sensitivity, Specificity and Area under Curve (AUC) were calculated for the two outcome tools and regression models calculated for every 3-domain frailty composite models.
Baseline frailty was assessed in 83 patients who underwent TAVR (mean age 82.3 years, males 52%, STS 9.2%, KCCQ Summary Score 34.11, Fried scale 3.6/5). There were 5 deaths (6%) and 25 procedural complications (36% total sample), based on prospective data from 2013-2015. KCCQ deemed 77/83 frail and Fried Scale deemed 72/83 frail using stated criteria and based on calculated Sensitivity and Specificity, AUC for KCCQ was 0.5324 versus Fried scale with AUC=0.6604. Next to grip strength, physical activity (measured by the Late-Life Function and Disability Index) was the strongest single-frailty predictor (AUC= 0.5704) and when both were combined with gait speed, this yielded the highest sensitivity/specificity for a 3-domain frailty composite (AUC=0.5962).
Fried scale should be utilized for assessing frailty in TAVR.
STRUCTURAL: Valvular Disease: Aortic