title: [Multidimensional geriatric assessment before transcatheter aortic valve implantation in frail elderly patients with one-year follow-up. Cardio-geriatrician collaboration benefits?].
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is a treatment for high-risk patients with symptomatic severe aortic stenosis. The aim of the study is to assess results of comprehensive geriatric assessment before TAVI and geriatrician advices about TAVI procedure feasibility. We report one-year outcomes after TAVI procedure.
  
  
  METHODS
  All patients who underwent comprehensive geriatric assessment in geriatric day hospital before TAVI were prospectively included in Grenoble. We report characteristics of the patients, geriatrician advices about TAVI procedure feasibility and risks, and one year follow-up.
  
  
  RESULTS
  Twenty-one frail elderly patients underwent geriatric assessment. The mean age was 85.4; demographics included cognitive impairment (76%), renal dysfunction (81%), NYHA functional class III or IV (48%). Eighteen patients were suitable for TAVI according to geriatric assessment, 8 underwent TAVI. None of the 3 patients who were not candidate for TAVI according to geriatricians were implanted. Cardiologists followed geriatrician advices for 56% of cases. Intensive care unit and cardiology stay were prolonged at 3.5 and 7.9days, respectively. Six out of the 8 patients stayed in rehabilitation unit after TAVI. None of the implanted patients died at one-year follow up, despite of the common periprocedural complications: acute kidney injury, ischemic stroke, delirium, pacemaker, hemorrhage.
  
  
  CONCLUSIONS
  Cardiologists follow geriatrician advices about TAVI feasibility in frail elderly patients. Comprehensive geriatric assessment also helps preventing complications and providing quick assessment of occurring periprocedural and postprocedural complications. Optimal management of frail elderly patients undergoing TAVI is a multidisciplinary task involving cardiologists, anaesthetists and geriatricians.
authors.affiliation: Pôle pluridisciplinaire de médecine et gérontologie clinique, clinique universitaire de médecine gériatrique, CHU Grenoble, 38000 Grenoble, France. Electronic address: dr.damier@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Damier
authors.affiliation: Pôle pluridisciplinaire de médecine et gérontologie clinique, clinique universitaire de médecine gériatrique, CHU Grenoble, 38000 Grenoble, France.
authors.forename: E
authors.initials: E
authors.lastname: Chidlovskii
authors.affiliation: Pôle cardiovasculaire et thoracique, clinique universitaire de cardiologie, CHU Grenoble, 38000 Grenoble, France.
authors.forename: B
authors.initials: B
authors.lastname: Bertrand
authors.affiliation: Pôle pluridisciplinaire de médecine et gérontologie clinique, clinique universitaire de médecine gériatrique, CHU Grenoble, 38000 Grenoble, France.
authors.forename: V M
authors.initials: VM
authors.lastname: Dang
authors.affiliation: Pôle cardiovasculaire et thoracique, clinique universitaire de cardiologie, CHU Grenoble, 38000 Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Vanzetto
authors.affiliation: Pôle pluridisciplinaire de médecine et gérontologie clinique, clinique universitaire de médecine gériatrique, CHU Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Couturier
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D000072096:Cardiologists; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D005602:France; D015577:Geriatric Assessment; D000072219:Geriatricians; D006801:Humans; D007902:Length of Stay; D008297:Male; D010348:Patient Care Team; D018579:Patient Selection; D011300:Preoperative Care; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement
keywords: Aortic valve stenosis; Comprehensive geriatric assessment; Frail elderly; Remplacement valvulaire aortique par voie percutanée; Rétrécissement aortique; Sujet âgé fragile; Transcatheter aortic valve implantation; Évaluation gériatrique standardisée