TAVI eligibility assessment: Interest of a coordinated cardiological and gerontological evaluation - 31/12/22
Résumé |
Introduction |
If TAVI is now the reference treatment for aortic stenosis in the elderly, the selection of patients (pts) who benefit from this procedure remains crucial.
Objective |
Retrospective evaluation of the efficiency of a TAVI selection process for patients at Arras hospital (AH).
Method |
Inclusion criteria: patients over 75years of age with a severe symptomatic RAO. Each pt was subject to a pre-selection phase including a cardiological and gerontological evaluation on AH and then a validation phase of the indication by the Artois heart team in lens Hospital, TAVI regional reference center.
Results |
In total, 192 pts, 86 men and 106 women with mean (±SD) age of 85±5.5years were evaluated between 2016 and 2020: 111 pts were eligible for TAVI (Gpe 1), 68 were contraindicated to any invasive treatment (Gpe 2) and 13 underwent valvular surgery (Gpe 3). Mortality at 1 year and at the end of follow-up was respectively 19% and 64% in Gpe 1, 45% and 93.5% in Gpe 2 and 8% and 45% in Gpe 3.
The predictive parameters of ineligibility for a TAVI procedure between Gpe 1 and Gpe 2 were (1) for cardiological parameters: EUROSCORE 1 (19.4 Gpe 1 vs. 24.4 Gpe 2; P=0.020) and history of decompensated heart failure (46.3% Gp1 vs. 61.8% Gp2; P=0.045). On the other hand, the STS score (4.2 Gpe 1 vs. 4.7 Gpe 2; P=0.061) was not significantly different between the 2 groups; (2) for geriatric parameters: malnutrition (14.1% Gpe 1 vs. 35.3% Gpe 2; P=0.004), cognitive disorders (minimal state examination: 25.2 Gpe 1 vs. 21.5 Gpe 2; P=0.001), walking speed<0.8m/s (39.5% Gpe 1 vs. 75.7% Gpe 2; P=0.001), balance disorders (42% Gpe 1 vs. 77% Gpe 2; P=0.001) loss of autonomy (ADL score 5.4 Gpe 1 vs. 4.1 Gpe 2; P=0.001), depression (mini-GDS: 15.9% Gpe 1 vs. 37.5% Gpe 2; P=0.045) were statistically more frequent in pts not eligible for TAVI.
Conclusion |
Geriatric syndromes are the essential determinants of the contraindication to TAVI. In this study, The STS, pivot of the ESC recommendations, does not seem to be discriminant. The gerontological evaluation of pts eligible for TAVI should not be optional, but systematic.
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Vol 15 - N° 1
P. 82 - janvier 2023 Retour au numéro
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