| dc.contributor.advisor | Schillinger, Wolfgang Prof. Dr. | |
| dc.contributor.author | Sobisiak, Bettina | |
| dc.date.accessioned | 2017-06-15T09:09:34Z | |
| dc.date.available | 2017-06-28T22:50:14Z | |
| dc.date.issued | 2017-06-15 | |
| dc.identifier.uri | http://hdl.handle.net/11858/00-1735-0000-0023-3E7A-0 | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-6349 | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-6349 | |
| dc.language.iso | deu | de |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject.ddc | 610 | de |
| dc.title | Einfluss der Gebrechlichkeit auf Morbidität und Mortalität nach kathetergestützter Aortenklappenimplantation (TAVI) | de |
| dc.type | doctoralThesis | de |
| dc.title.translated | Impact of frailty on morbidity and mortality after transcatheter aortic valve implantation (TAVI) | de |
| dc.contributor.referee | Nau, Roland Prof. Dr. | |
| dc.date.examination | 2017-06-21 | |
| dc.description.abstracteng | 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. | de |
| dc.contributor.coReferee | Schön, Margarete Prof. Dr. | |
| dc.subject.ger | Gebrechlichkeit | de |
| dc.subject.ger | TAVI | de |
| dc.subject.eng | transcatheter aortic-valve implantation | de |
| dc.subject.eng | TAVI | de |
| dc.subject.eng | frailty | de |
| dc.subject.eng | Aortic Stenosis | de |
| dc.subject.eng | Katz Index | de |
| dc.subject.eng | Activities of Daily Living | de |
| dc.identifier.urn | urn:nbn:de:gbv:7-11858/00-1735-0000-0023-3E7A-0-6 | |
| dc.affiliation.institute | Medizinische Fakultät | de |
| dc.subject.gokfull | Innere Medizin - Allgemein- und Gesamtdarstellungen (PPN619875747) | de |
| dc.subject.gokfull | Geriatrie / Gerontologie / Altenpflege - Allgemein- und Gesamtdarstellungen (PPN61987662X) | de |
| dc.description.embargoed | 2017-06-28 | |
| dc.identifier.ppn | 890434093 | |