Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation

Background For selected patients with symptomatic aortic stenosis, transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR). In addition to co-morbidities, frailty has to be taken into account in the decision-making process. Criteria for patient selection, according to current guidelines, include EuroSCORE and STS score but frailty is not easy to quantify. ISAR (Identifi cation of Seniors At Risk) detects seniors at risk for adverse health outcome after an emergency visit and SHERPA (Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie) assesses the risk of functional decline after hospitalization. Objectives The aim of the present study was to evaluate the impact of ISAR and SHERPA scores in the prediction of patient outcome after TAVI. Methods and results A prospective cohort of 30 consecutive octogenarian patients (16 males, 86 ± 3 y, EuroSCORE 34 ± 12%) underwent a transfemoral TAVI and a complete geriatric assessment in our institution. Survival at one year was 73%. The ISAR score was similar between both groups (3.1 ± 1 vs. 3.6 ± 1; P = 0.10) but the SHERPA score was signifi cantly higher in non-survivors (7.8 ± 1.6) than among survivors (4.9 ± 2.4; P = 0.001). With multivariate analysis, SHERPA score and BMI were independent predictors of 1-year mortality. Kaplan-Meier analysis showed that 1-year survival was signifi cantly lower in patients with than in those without a SHERPA score > 7 (40 vs. 89%; P = 0.004). Conclusions The result of this study showed that SHERPA score predicts 1-year survival after transfemoral TAVI and could be considered as a useful frailty score in patient selection.