Assisted care as a baseline patient risk characteristic affecting the outcome of transcatheter aortic valve insertion

Background: Objective measures of frailty have not been well defined as risk factors for a poor outcome after transcatheter aortic valve insertion. We hypothesized that assisted care as a baseline patient characteristic was a simple objective measure of frailty. We reviewed our experience to assess for an association between assisted care and outcome of operation. Methods: We retrospectively reviewed the records of 597 patients operated with transcatheter aortic valve insertion from November 2008 through July 2015. The study cohort included patients with a dichotomous baseline characteristic of receiving assisted care (AC group, n=60, 10.1%) or not receiving assisted care (NC group, n=537, 89.9%). The endpoints of the study were operative stroke/death and 1-year survival. Results: The age of the patients was 80.6±9.0 years, male sex was present in 349 (58.5%), and STS predicted risk of mortality was 9.2±6.2%. Alternate access was used in 26 (43.3%) patients in the AC care group and in 220 (41.0%) in the NC group (P=0.724). Operative stroke/death occurred in 4 (6.7%) patients in the AC group and in 25 (4.7%) in the NC group (P=0.492). Mortality at 1 year in the AC group was 14.8±5.2% and in the NC group was 12.9±1.7%; (P=0. 250). Conclusions: Assisted care as a baseline patient characteristic does not result in increased operative stroke/death or 1-year mortality in patients following transcatheter aortic valve insertion. Assisted care should not by itself preclude operation.