Frailty and Five-Year Mortality After TAVR in Patients Aged 75 Years and Older.

Background

Transcatheter aortic valve replacement (TAVR) is the standard treatment for older adults with symptomatic severe aortic stenosis. While cardiovascular predictors of long-term mortality after TAVR are well established, the impact of geriatric factors beyond short-term outcomes remains poorly defined. The main objective was to evaluate the association between geriatric factors and five-year all-cause mortality in patients aged 75 years and older undergoing TAVR.

Methods

This study is a single-center retrospective analysis of prospectively collected data at Nantes University Hospital, France. All consecutive patients aged ≥ 75 years who underwent TAVR between January 2012 and December 2018 and received a standardized pre-procedural geriatric assessment were included. Geriatric assessment included nutritional status, physical performance, functional status, cognition, comorbidities, and frailty assessed using the Rockwood Clinical Frailty Scale (CFS). Multivariate cox regression was used to identify factors independently associated with mortality.

Results

Among 976 patients included, median age was 84 years and 48% were men. Five-year mortality was 46%. In multivariate analysis, frailty assessed by the CFS was independently but modestly associated with five-year mortality (HR 1.12; 95% CI 1.01-1.26). No other geriatric variables were independently associated with five-year mortality. Five-year mortality increased across frailty categories, from 38% in robust patients to 55% in severely frail patients (p = 0.005).

Conclusion

Among patients aged 75 years and older undergoing TAVR, frailty assessed by Rockwood's CFS was the most robust geriatric predictor of five-year mortality. These findings support the integration of frailty assessment into long-term prognostic evaluation and highlight the potential value of combined cardiology and geriatric follow-up after TAVR.