Prognostic value of a comprehensive geriatric assessment for predicting one-year mortality in presumably frail patient with symptomatic aortic stenosis
Camarzana Audrey 1  
,   ANNWEILER Cédric 2  
,   PINAUD Frédéric 3  
,   ABI-KHALIL Wissam 1  
,   ROULEAU Frédéric 1  
,   DUVAL Guillaume 2  
,   PRUNIER Fabrice 1  
,   FURBER Alain 1  
,   BIERE Loïc 1  
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Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, Angers, 49000, France
Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity, University Hospital, Angers, France; UPRES EA 4638, University of Angers, Angers, France
Department of Cardiac surgery, University hospital of Angers, Angers, France
BIERE Loïc   

Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, Angers, 49000, France
Submission date: 2018-12-03
Final revision date: 2019-04-28
Acceptance date: 2019-05-16
Online publication date: 2021-03-24
Despite of suffering a severe aortic stenosis, some patients are denied from either surgical or Transcatheter Aortic Valve Implantation (TAVI) therapy because of a frail condition. We aim to identify whether a comprehensive geriatric assessment (CGA) might be useful to predict prognosis of presumably frail patients with severe aortic stenosis.

Material and methods:
Between March 2011 and July 2016, 818 patients were consecutively and prospectively enrolled. 161 had a CGA and were considered for analysis. Considering combined CGA and Heart team recommendations, 102 TAVI were performed (TAVI group) and 59 patients constituted the no TAVI group. Primary endpoint was all-cause mortality at one year.

There was no difference between the TAVI and the no TAVI groups considering morphometric data, cardiovascular risk factors or symptoms. The no TAVI group had higher surgical risk (logistic EuroSCORE1 33.4±17.8 vs. 22.7±14.9; p<0.001) and more moderate renal insufficiency (82% vs. 57%; p=0.001). One-year mortality was 16% in the TAVI group and 46% in the no TAVI group (p<0.001). Multivariate analysis revealed history of pulmonary edema, moderate renal failure, and not having a TAVI, to relate to 1-year mortality. There was an interaction of the Five-Times-Sit-to-Stand-Test (FTSST) upon the effect of TAVI on mortality (p=0.049), as FTSST was the only predictor for 1-year mortality in the no TAVI group (HR:0.18 95%CI 0.04–0.76; p=0.019).

One-year mortality was higher in geriatric-assessed frail patient who did not undergo TAVI. FTSST, which assesses patients’ mobility, was the only prognostic marker for 1-year mortality, on top of usual medical parameters.