Einfluss der Gebrechlichkeit auf Morbidität und Mortalität nach kathetergestützter Aortenklappenimplantation (TAVI)

Impact of frailty on morbidity and mortality after transcatheter aortic valve implantation (TAVI)

by Bettina Sobisiak
Doctoral thesis
Date of Examination:2017-06-21
Date of issue:2017-06-15
Advisor:Prof. Dr. Wolfgang Schillinger
Referee:Prof. Dr. Roland Nau
Referee:Prof. Dr. Margarete Schön
Persistent Address: http://dx.doi.org/10.53846/goediss-6349

 

 

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Abstract

English

Background: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by Katz Index of Activities of Daily Living (ADL) on short- and long-term mortality after TAVI. Methods and Results: Our study includes 300 consecutive patients (mean age, 82±5 years) who underwent TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3% immediate procedural mortality, 17% vs. 5.8% 30d-mortality, and 23% vs. 6.4% procedural mortality). The risk-score-based 30d-mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) did neither reflect the observed 30d-mortality in both groups nor the 3-fold risk elevation in frail patients. In contrast, the Katz Index <6 could be identified as significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67, P<0.0001): During follow-up (median observation period 537 days), 55% of frail vs. 24% of non-frail patients died. Conclusions: Frailty status measured by Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
Keywords: transcatheter aortic-valve implantation; TAVI; frailty; Aortic Stenosis; Katz Index; Activities of Daily Living
Schlagwörter: Gebrechlichkeit; TAVI
 
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