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Severe aortic stenosis and transcatheter aortic valve replacement in elderly patients: utility vs futility
- Publication Year :
- 2021
-
Abstract
- Introduction Recently, transcatheter aortic valve replacement (TAVR) has emerged as established standard treatment for symptomatic severe aortic stenosis, providing an effective, less-invasive alternative to open cardiac surgery for inoperable or high-risk older patients. Evidence acquisition In order to assess the anticipated benefit of aortic replacement, considerable interest now lies in better identifying factors likely to predict outcome. In the elderly population frailty and medical comorbidities have been shown to significantly predict mortality, functional recovery and quality of life after transcatheter aortic valve replacement. Scientific literature focused on the three items will be discussed. Evidence synthesis High likelihood of futility is described in patients with severe chronic lung, kidney, liver disease and/or frailty. The addition of frailty components to conventional risk prediction has been shown to result in improved discrimination for death and disability following the procedure and identifies those individuals least likely to derive benefit. Several dedicated risk score have been proposed to provide new insights into predicted "futile" outcome. However, assessment of frailty according to a limited number of variables is not sufficient, while a multi-dimensional geriatric assessment significantly improves risk prediction. Conclusions A multidisciplinary heart team that includes geriatricians can allow the customization of therapeutic interventions in elderly patients to optimise care and avoid futility.
- Subjects :
- medicine.medical_specialty
Frail Elderly
medicine.medical_treatment
Psychological intervention
MEDLINE
Risk Assessment
Severity of Illness Index
Transcatheter Aortic Valve Replacement
Valve replacement
Quality of life
Risk Factors
medicine
Humans
Intensive care medicine
Aged
Framingham Risk Score
Frailty
business.industry
Standard treatment
Aortic Valve Stenosis
General Medicine
medicine.disease
Cardiac surgery
Stenosis
Treatment Outcome
Aortic Valve
Quality of Life
business
Medical Futility
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....a067baf58fadb72f862e0d42f3930f31