The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: A systematic review and meta-analysis

Abstract

Aims Transcatheter aortic valve implantation (TAVI) is an increasingly common intervention for patients with aortic stenosis deemed high risk for major cardiac surgery, but identifying those who will benefit can be challenging. Frailty reflects physiological reserve and may be a useful prognostic marker in this population. We performed a systematic review and meta-analysis of the association between frailty and outcomes after TAVI. Methods and results Five databases were searched between January 2000 and May 2015. From 2623 articles screened, 54 were assessed for eligibility. Ten cohort studies (n = 4592) met the inclusion criteria of reporting a measure of frailty with early (=30 days) or late (>30 days) mortality and procedural complications following TAVI as defined by the Valve Academic Research Consortium (VARC). Frailty was associated with increased early mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P < 0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63, 95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P < 0.001). Frail individuals undergoing TAVI have a mortality rate of 34 deaths per 100 patient years, compared with 19 deaths per 100 patient years in non-frail patients. There was limited reporting of VARC procedural outcomes in relation to frailty, preventing meta-analysis. Conclusion Frailty assessment in an already vulnerable TAVI population identifies individuals at even greater risk of poor outcomes. Use of objective frailty tools may inform patient selection, but this requires further assessment in large prospective registries.