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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Eur+Heart+J+Suppl
2017 ; 19
(Suppl D
): D354-D369
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk
Stratification in elderly patients with aortic stenosis before surgery or
transcatheter aortic valve replacement
#MMPMID28751850
Pulignano G
; Gulizia MM
; Baldasseroni S
; Bedogni F
; Cioffi G
; Indolfi C
; Romeo F
; Murrone A
; Musumeci F
; Parolari A
; Patanč L
; Pino PG
; Mongiardo A
; Spaccarotella C
; Di Bartolomeo R
; Musumeci G
Eur Heart J Suppl
2017[May]; 19
(Suppl D
): D354-D369
PMID28751850
show ga
Aortic stenosis is one of the most frequent valvular diseases in developed
countries, and its impact on public health resources and assistance is
increasing. A substantial proportion of elderly people with severe aortic
stenosis is not eligible to surgery because of the advanced age, frailty, and
multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables
the treatment of very elderly patients at high or prohibitive surgical risk
considered ineligible for surgery and with an acceptable life expectancy.
However, a significant percentage of patients die or show no improvement in
quality of life (QOL) in the follow-up. In the decision-making process, it is
important to determine: (i) whether and how much frailty of the patient
influences the risk of procedures; (ii) how the QOL and the individual patient's
survival are influenced by aortic valve disease or from other associated
conditions; and (iii) whether a geriatric specialist intervention to evaluate and
correct frailty or other diseases with their potential or already manifest
disabilities can improve the outcome of surgery or TAVI. Consequently, in
addition to risk stratification with conventional tools, a number of factors
including multi-morbidity, disability, frailty, and cognitive function should be
considered, in order to assess the expected benefit of both surgery and TAVI. The
pre-operative optimization through a multidisciplinary approach with a Heart Team
can counteract the multiple damage (cardiac, neurological, muscular, respiratory,
and kidney) that can potentially aggravate the reduced physiological reserves
characteristic of frailty. The systematic application in clinical practice of
multidimensional assessment instruments of frailty and cognitive function in the
screening and the adoption of specific care pathways should facilitate this task.