Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from c...Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.展开更多
Objective To evaluate immediate transcatheter aortic valve implantation （TAVI） results and medium-term follow-up in very elderly pa- tients with severe and symptomatic aortic stenosis （AS）. Methods This multicente...Objective To evaluate immediate transcatheter aortic valve implantation （TAVI） results and medium-term follow-up in very elderly pa- tients with severe and symptomatic aortic stenosis （AS）. Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly （〉 85 years） patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rotes from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years （range from 85 to 94 years） and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 （35.6%） patients scoring 〉 20%. Procedural success rate was 97.5%, with 25 （15.6%） patients experiencing acute complications with major bleeding （the most frequent）. Global mortality rate during hospitalization was 8.8% （n = 14） and 30-day mortality rate was 10% （n = 16）. Median follow up period was 252.24± 232.17 days. During the follow-up period, 28 （17.5%） patients died （17 of them due to cardiac causes）. The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique vari- able associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.展开更多
文摘Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.
文摘Objective To evaluate immediate transcatheter aortic valve implantation （TAVI） results and medium-term follow-up in very elderly pa- tients with severe and symptomatic aortic stenosis （AS）. Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly （〉 85 years） patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rotes from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years （range from 85 to 94 years） and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 （35.6%） patients scoring 〉 20%. Procedural success rate was 97.5%, with 25 （15.6%） patients experiencing acute complications with major bleeding （the most frequent）. Global mortality rate during hospitalization was 8.8% （n = 14） and 30-day mortality rate was 10% （n = 16）. Median follow up period was 252.24± 232.17 days. During the follow-up period, 28 （17.5%） patients died （17 of them due to cardiac causes）. The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique vari- able associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.
