Author + information
- Laura Drudi,
- Matthew Ades,
- Rita Mancini,
- Melissa Bendayan,
- Amanda Trnkus and
- Jonathan Afilalo
Background: We hypothesized that frail older adults may be less capable of tolerating the operative stress associated with non-femoral transcatheter aortic valve replacement (TAVR) and face a higher risk of 30-day mortality as compared to robust patients.
Methods: This study was a post hoc analysis of older adults that underwent TAVR in the FRAILTY-AVR multicenter study. To determine the effect of access site on 30-day mortality, multivariable logistic regression models were stratified according to frailty status and adjusted for the STS-predicted risk of mortality and peripheral arterial disease. Frailty was assessed using the short physical performance battery (SPPB), with scores of ≤5 indicative of frailty. Effect modification was calculated on the additive and multiplicative scales.
Results: The cohort consisted of 638 adults with a mean age of 84 ± 6 years, of which 492 (77%) had femoral access and 146 (23%) had non-femoral access. In frail patients with low SPPB score ≤5 (42%), non-femoral access was associated with increased 30-day mortality (OR 3.54, 95% CI 1.43, 8.76); whereas in patients with SPPB >5 (58%), non-femoral access had no effect (OR 1.04, 95% CI 0.28, 3.88). There was evidence of effect modification between frailty and access site on the additive scale and a trend on the multiplicative scale.
Conclusions: The risk of mortality is 3-fold higher when frail older adults undergo TAVR via a non-femoral access route, while robust patients’ survival do not appear to be influenced by access route.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Complexity and Complications
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1285-160
- 2017 American College of Cardiology Foundation