Abstract 10342: Frailty Status and Outcomes Following Trans-catheter Aortic Valve Replacement

Abstract

Introduction: Frailty is associated with increased disability, morbidity, and mortality. We assessed the impact of frailty status on outcomes following trans-catheter aortic valve replacement (TAVR). Methods: We included all 142 patients who underwent prospective modified Fried frailty assessments prior to TAVR at a single tertiary care academic medical center between February, 2012 and February, 2015 in a retrospective cohort study. We stratified patients into 3 groups (non-frail, pre-frail, and frail). The primary outcome was a composite of 30 day mortality, stroke, acute kidney injury > stage 2, major vascular injury, major or life-threatening bleeding, valve malpositioning, conversion to sternotomy, and respiratory failure. Secondary outcomes included length of hospital stay, discharge destination, hospital re-admission within 30 days, and overall survival. Results: Non-frailty was present in 39 patients (27%), pre-frailty in 64 patients (45%), and frailty in 39 patients (27%). Mean age increased with increasing frailty status (non-frail 80.1 +/- 9.3 years, pre-frail 84.0 +/- 8.2 years, frail 84.7 +/- 7.1 years, P=0.03). There was no difference in the mean Society of Thoracic Surgeons risk score between groups. There was no difference in the rate of the primary composite endpoint, length of hospital stay, rate of hospital re-admission within 30 days, or overall survival between the groups. Frail patients had a higher rate of discharge to a rehabilitation facility (non-frail 23%, pre-frail 23%, frail 51%, P<0.01). In a multivariable logistic regression, frailty was a significant independent predictor of discharge to a rehabilitation facility (table). Conclusions: Outcomes following TAVR are not impacted by pre-frailty, while frail patients are less likely to be discharged directly home.