scholarly journals Rockwood Clinical Frailty Scale as a predictor of adverse outcomes among older adults undergoing aortic valve replacement: a protocol for a systematic review

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e049216
Author(s):  
Tadhg Prendiville ◽  
Aoife Leahy ◽  
Laura Quinlan ◽  
Anastasia Saleh ◽  
Elaine Shanahan ◽  
...  
Keyword(s):  
Older Adults ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Preoperative Assessment ◽  
Adverse Outcomes ◽  
Primary Data ◽  
Evaluation Tool ◽  
Surgical Aortic Valve Replacement ◽  
Clinical Frailty Scale

IntroductionFrailty is associated with adverse outcomes relating to cardiac procedures. It has been proposed that frailty scoring should be included in the preoperative assessment of patients undergoing aortic valve replacement. We aim to examine the Rockwood Clinical Frailty Scale (CFS), as a predictor of adverse outcomes following aortic valve replacement.Methods and analysisProspective and retrospective cohort studies and randomised controlled trials assessing both the preoperative frailty status (as per the CFS) and incidence of adverse outcomes among older adults undergoing either surgical aortic valve replacement or transcatheter aortic valve replacement will be included. Adverse outcomes will include mortality and periprocedural complications, as well as a composite of 30-day complications. A search will be conducted from 2005 to present using a prespecified search strategy. Studies will be screened for inclusion by two reviewers, with methodological quality assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Relative risk ratios with 95% CIs will be generated for each outcome of interest, comparing frail with non-frail groups. Data will be plotted on forest plots where applicable. The quality of the evidence will be determined using the Grading of Recommendations, Assessment, Development and Evaluation tool.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. We will publish the review in a peer-reviewed journal on completion.PROSPERO registration numberCRD42020213757.

scholarly journals Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 191 ◽  
Author(s):  
Laura M. Drudi ◽  
Matthew Ades ◽  
Sena Turkdogan ◽  
Caroline Huynh ◽  
Sandra Lauck ◽  
...  
Keyword(s):  
Older Adults ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement

scholarly journals Short-Term Outcomes of Transcatheter Versus Isolated Surgical Aortic Valve Replacement for Mediastinal Radiation-Associated Severe Aortic Stenosis

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Victor Nauffal ◽  
Camden Bay ◽  
Pinak B. Shah ◽  
Piotr S. Sobieszczyk ◽  
Tsuyoshi Kaneko ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Pacemaker Implantation ◽  
Careful Consideration ◽  
Adverse Outcomes ◽  
Surgical Aortic Valve Replacement ◽  
Mediastinal Radiation

Background: Surgical aortic valve replacement (SAVR) is associated with adverse outcomes in patients with radiation-associated aortic stenosis. Transcatheter aortic valve replacement (TAVR) may improve outcomes in this population. Methods: We evaluated 1668 TAVR and 2611 patients with SAVR enrolled in the Society of Thoracic Surgeons’ database between 2011 and 2018. Multiple logistic regression was used to compare 30- day outcomes between TAVR and SAVR. Propensity-matched analysis was performed to confirm results of the overall cohort. Additionally, the cohort was stratified into early (2011–2014) versus contemporary (2015–2018) TAVR eras, and 30-day outcomes for TAVR and SAVR were compared. Finally, outcomes with transfemoral TAVR versus SAVR were compared. Results: In the overall cohort, TAVR was associated with significantly reduced 30-day mortality (odds ratio [OR] TAVR/SAVR =0.60 [0.40–0.91]). Postoperative atrial fibrillation, pneumonia, pleural effusion, renal failure, and bleeding also occurred less frequently with TAVR. Stroke/transient ischemic attack (TIA; OR TAVR/SAVR , 2.03 [1.09–3.77]) and pacemaker implantation (OR TAVR/SAVR , 1.62 [1.21–2.17]) were higher with TAVR. Propensity-matched analysis yielded similar results as the overall cohort. Following stratification by era, TAVR versus SAVR was associated with reduced 30-day mortality in the contemporary but not early era (OR Early , 0.78 [0.48–1.28]; OR Contemporary , 0.31 [0.14–0.65]). Pacemaker implantation was higher with TAVR versus SAVR in both eras (OR Early , 1.60 [1.03–2.46]; OR Contemporary , 1.64 [1.10–2.45]). There was also a nonsignificant trend towards increased stroke/TIA with TAVR during both eras (OR Early , 1.39 [0.58–3.36]; OR Contemporary , 2.46 [0.99–6.10]). Finally, transfemoral TAVR (N=1369) versus SAVR revealed similar findings as the overall cohort; however, the association of TAVR with stroke/TIA was not statistically significant (OR Stroke/TIA , 1.57 [0.79–3.09]). Conclusions: TAVR provides an effective and evolving alternative to SAVR for radiation-associated severe aortic stenosis and was associated with lower 30-day mortality and postoperative complications. TAVR was associated with increased pacemaker implantation and a trend towards increased stroke/TIA. In this unique population with extensive valvular and vascular calcifications, the risk of stroke/TIA with TAVR requires careful consideration and further investigation.

scholarly journals Frailty, disability and comorbidity: different domains lead to different effects after surgical aortic valve replacement in elderly patients

2019 ◽  
Vol 29 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Miguel Piñón ◽  
Emilio Paredes ◽  
Beatriz Acuña ◽  
Sergio Raposeiras ◽  
Elena Casquero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Cardiovascular Health Study ◽  
Transfusion Rate ◽  
Safe Procedure ◽  
Surgical Aortic Valve Replacement

Abstract OBJECTIVES Frailty syndrome predicts adverse outcomes after surgical aortic valve replacement. However, disability or comorbidity is frequently associated with preoperative frailty evaluation. The effects of these domains on early and late outcomes were analysed. METHODS A prospective study including patients aged ≥75 years with symptomatic severe aortic stenosis who received aortic valve replacement with or without coronary artery bypass grafting was conducted. We used the Cardiovascular Health Study Frailty Phenotype to assess frailty, the Lawton–Brody index to define disability and the Charlson comorbidity index (CCI) to evaluate comorbidity. RESULTS Frailty was identified in 57 (31%), dependence in 18 (9.9%) and advanced comorbidity (CCI ≥ 4) in 67 (36.6%) of the 183 enrolled patients. Operative mortality (1.6%), transfusion rate and duration of stay increased in patients with CCI ≥4 (P < 0.005). There was a non-significant trend for these adverse outcomes among the frail patients. Follow-up was achieved in all patients (median/interquartile range 869/699–1099 days). Kaplan–Meier univariable analysis showed a reduced survival rate for frail and dependent patients and for those with multiple comorbidities (P < 0.05). According to multivariable analysis, frailty and comorbidity were independent risk factors for 1-year mortality, while disability and comorbidity, but not frailty, were risk factors for 3-year mortality (P < 0.05). CONCLUSIONS Surgical aortic valve replacement in patients aged ≥75 years is a safe procedure with low mortality rates. Operative outcomes are mainly affected by comorbidities. The main influence of survival occurs throughout the first year, and an improved functional status prevents any progression towards disabilities, which could potentially benefit long-term outcomes. Clinical trial registration number NCT02745314

scholarly journals The Course of Circulating Small Extracellular Vesicles in Patients Undergoing Surgical Aortic Valve Replacement

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Andreas Weber ◽  
Shining Sophie Liu ◽  
Letizia Cardone ◽  
Philipp Rellecke ◽  
Stephan Urs Sixt ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Extracellular Vesicles ◽  
Peripheral Blood ◽  
Cell Communication ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Interventions

In the last years, increasing efforts have been devoted to investigating the role of small extracellular vesicles (sEVs) in cardiovascular diseases. These nano-sized particles (30-150 nm), secreted by different cell types, contain signalling molecules that enable participation in intercellular communication processes. In this study, we examined the course of circulating sEVs in patients undergoing surgical aortic valve replacement (SAVR) and correlated them with echocardiographic and standard blood parameters. Peripheral blood samples were collected from 135 patients undergoing SAVR preoperatively and at three follow-up points. Circulating sEVs were precipitated using Exoquick™ exosome isolation reagent and analyzed by nanoparticle tracking analysis (NTA). Our findings indicate that no more than 7 days after SAVR, there was a marked increase of circulating sEVs before returning to initial values after 3 months. Further, shear stress is not a trigger for the formation and release of circulating sEVs. Moreover, we pointed out a correlation between circulating sEVs and erythrocytes as well as LDH and creatinine levels in peripheral blood. Finally, all patients with a moderate prosthesis-patient mismatch as well as with an impaired left ventricular mass regression had lower levels of circulating sEVs 3 months after SAVR compared to their respective status before surgery. We conclude that in patients with aortic valve stenosis (AVS), sEVs may play an important part in mediating cell-cell communication and SAVR may have a crucial and lasting impact on their circulating levels. Besides, lower levels of sEVs portend to be associated with inferior recovery after major surgical interventions. The additional use of circulating sEVs beyond echocardiographic and laboratory parameters could have a prognostic value to estimate adverse outcomes in patients undergoing SAVR.

scholarly journals Cognition and Cerebral Infarction in Older Adults After Surgical Aortic Valve Replacement

2019 ◽  
Vol 107 (3) ◽  
pp. 787-794 ◽  
Author(s):  
Tania Giovannetti ◽  
Catherine C. Price ◽  
Molly Fanning ◽  
Steven Messé ◽  
Sarah J. Ratcliffe ◽  
...  
Keyword(s):  
Older Adults ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Cerebral Infarction ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement
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