Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation - results from the CGA-TAVI multicentre registry

Andrea Ungar, Giulio Mannarino, Nathalie van der Velde, Jan Baan, Marie-Pierre Thibodeau, Jean-Bernard Masson, Gennaro Santoro, Martijn van Mourik, Sofie Jansen, Cornelia Deutsch, Peter Bramlage, Jana Kurucova, Martin Thoenes, Stefania Maggi, Andreas W Schoenenberger, Andrea Ungar, Giulio Mannarino, Nathalie van der Velde, Jan Baan, Marie-Pierre Thibodeau, Jean-Bernard Masson, Gennaro Santoro, Martijn van Mourik, Sofie Jansen, Cornelia Deutsch, Peter Bramlage, Jana Kurucova, Martin Thoenes, Stefania Maggi, Andreas W Schoenenberger

Abstract

Background: In older patients with aortic stenosis (AS) undergoing TAVI, the potential role of prior CGA is not well established. To explore the value of comprehensive geriatric assessment (CGA) for predicting mortality and/or hospitalisation within the first 3 months after transcatheter aortic valve implantation (TAVI).

Methods: An international, multi-centre, prospective registry (CGA-TAVI) was established to gather data on CGA results and medium-term outcomes in geriatric patients undergoing TAVI. Logistic regression was used to evaluate the predictive value of a multidimensional prognostic index (MPI); a short physical performance battery (SPPB); and the Silver Code, which was based on administrative data, for predicting death and/or hospitalisation in the first 3 months after TAVI (primary endpoint).

Results: A total of 71 TAVI patients (mean age 85.4 years; mean log EuroSCORE I 22.5%) were enrolled. Device success according to VARC criteria was 100%. After adjustment for selected baseline characteristics, a higher (poorer) MPI score (OR: 3.34; 95% CI: 1.39-8.02; p = 0.0068) and a lower (poorer) SPPB score (OR: 1.15; 95% CI: 1.01-1.54; p = 0.0380) were found to be associated with an increased likelihood of the primary endpoint. The Silver Code did not show any predictive ability in this population.

Conclusions: Several aspects of the CGA have shown promise for being of use to physicians when predicting TAVI outcomes. While the MPI may be useful in clinical practice, the SPPB may be of particular value, being simple and quick to perform. Validation of these findings in a larger sample is warranted.

Trial registration: The trial was registered in ClinicalTrials.gov on November 7, 2013 ( NCT01991444 ).

Keywords: Comprehensive geriatric assessment (CGA); Multidimensional prognostic index (MPI); Short physical performance battery (SPPB); Silver code; Transcatheter aortic valve implantation (TAVI).

Conflict of interest statement

Ethics approval and consent to participate

All enrolled patients provided written informed consent. The study was conducted in accordance with the Declaration of Helsinki and approved by the responsible ethics committee at each participating site: Careggi Hospital, Florence, Italy (Comitato Etico Area Vasta Centro), Academic Medical Center, Amsterdam, the Netherlands (Medisch Ethische Toetsingscommissie) and Centre Hospitalier de l’Université de Montréal, Canada (Comite d’Ethique de la Recherche et du Developpement des Nouvelles Technologies).

Consent for publication

Not applicable.

Competing interests

Jan Baan and Peter Bramlage received research funding from Edwards Lifesciences, as did Andrea Ungar. Jean-Bernard Masson is a consultant for Edwards Lifesciences. Jana Kurucova is an employee of Edwards Lifesciences. The other authors declare no conflict of interest in relation to this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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