Post-TAVI management of frail patients: outcomes beyond implantation

Over the past decade, the number of patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI) has increased. This rise is attributed to advancements in device technology, which have led to long-term survival comparable to surgical replacement and lower complication rates, including paravalvular leak and need for pacemaker implantation. Consequently, TAVI is now indicated for patients with not only intermediate-to-high risk, but also low risk.1,2 Although pre-TAVI assessment using traditional surgical risk scores, such as EuroSCORE II and STS-PROM, is useful to categorize patients into low, intermediate, or high risk for this procedure, the latest clinical practice guidelines3 recommend a comprehensive assessment, based on clinical and functional measures of the patients, to determine their frailty, and using validated scales to exclude the clinical cardiologist’s subjectivity during consultation.4 This is of paramount importance because frail patients account for 30% of TAVI cases, and it is well known that frailty acts as an independent predictor of mortality and complications after TAVI. However, a patient being categorized as frail does not automatically mean that TAVI will be futile; rather, it indicates that additional measures, beyond alleviating valvular heart disease, should be implemented to improve the patient’s quality of life and survival.5 In...