Assisted care as a baseline patient risk characteristic affecting the outcome of transcatheter aortic valve insertion.
BACKGROUND
Objective measures of frailty have not been well defined as risk factors for a poor outcome after transcatheter aortic valve insertion. We hypothesized that assisted care as a baseline patient characteristic was a simple objective measure of frailty. We reviewed our experience to assess for an association between assisted care and outcome of operation.


METHODS
We retrospectively reviewed the records of 597 patients operated with transcatheter aortic valve insertion from November 2008 through July 2015. The study cohort included patients with a dichotomous baseline characteristic of receiving assisted care (AC group, n = 60, 10.1%) or not receiving assisted care (NC group, n = 537, 89.9%). The endpoints of the study were operative stroke/death and 1-year survival.


RESULTS
The age of the patients was 80.6 ± 9.0 years, male sex was present in 349 (58.5%), and STS predicted risk of mortality was 9.2 ± 6.2%. Alternate access was used in 26 (43.3%) patients in the AC care group and in 220 (41.0%) in the NC group (P = 0.724). Operative stroke/death occurred in 4 (6.7%) patients in the AC group and in 25 (4.7%) in the NC group (P = 0.492). Mortality at 1 year in the AC group was 14.8 ± 5.2% and in the NC group was 12.9 ± 1.7%; (P = 0. 250).


CONCLUSIONS
Assisted care as a baseline patient characteristic does not result in increased operative stroke/death or 1-year mortality in patients following transcatheter aortic valve insertion. Assisted care should not by itself preclude operation. © 2016 Wiley Periodicals, Inc.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Megan M
http://orcid.org/0000-0002-3774-3444
MM
Traynor
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Kevin L
KL
Greason
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Vuyisile T
VT
Nkomo
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Alberto
A
Pochettino
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
David R
DR
Holmes
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Charanjit S
CS
Rihal
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Guy S
GS
Reeder
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
John F
JF
Bresnahan
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.|Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Verghese
V
Mathew
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D040561:Assisted Living Facilities; D005260:Female; D000073496:Frailty / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008910:Minnesota; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
assisted care; transcatheter aortic valve insertion