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ANMCO/SIC/SICI-GISE/SICCH Consensus document: Risk stratification in elderly patients undergoing cardiac surgery and transcatheter aortic valve implantation

Pulignano, Giovanni ; Gulizia, Michele Massimo ; Baldasseroni, Samuele ; Bedogni, Francesco ; Cioffi, Giovanni ; Indolfi, Ciro ; Romeo, Francesco ; Murrone, Adriano ; Musumeci, Francesco ; Parolari, Alessandro ; Patanè, Leonardo ; Pino, Paolo Giuseppe ; Mongiardo, Annalisa ; Spaccarotella, Carmen ; Di Bartolomeo, Roberto ; Musumeci, Giuseppe

Giornale italiano di cardiologia (2006), 2016-09, Vol.17 (9), p.756 [Periódico revisado por pares]

Italy

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Título:
ANMCO/SIC/SICI-GISE/SICCH Consensus document: Risk stratification in elderly patients undergoing cardiac surgery and transcatheter aortic valve implantation
Autor: Pulignano, Giovanni ; Gulizia, Michele Massimo ; Baldasseroni, Samuele ; Bedogni, Francesco ; Cioffi, Giovanni ; Indolfi, Ciro ; Romeo, Francesco ; Murrone, Adriano ; Musumeci, Francesco ; Parolari, Alessandro ; Patanè, Leonardo ; Pino, Paolo Giuseppe ; Mongiardo, Annalisa ; Spaccarotella, Carmen ; Di Bartolomeo, Roberto ; Musumeci, Giuseppe
Assuntos: Age Factors ; Aged ; Algorithms ; Aortic Valve Stenosis - surgery ; Cardiac Surgical Procedures - standards ; Decision Trees ; Humans ; Patient Selection ; Risk Assessment ; Transcatheter Aortic Valve Replacement - standards ; Treatment Outcome
É parte de: Giornale italiano di cardiologia (2006), 2016-09, Vol.17 (9), p.756
Descrição: Aortic stenosis is one the most frequent valvular diseases in developed countries, and its impact on public healthcare resources and assistance is increasing. A substantial proportion of elderly patients with severe aortic stenosis is frequently not eligible for surgery because of advanced age, frailty and multiple comorbidities. 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 proportion of patients die or do not achieve an improvement of quality of life in the short to medium-term follow-up. It is important to determine: 1) whether and how much patient frailty influences the procedural risk; 2) whether quality of life and the individual patient survival are influenced by aortic valve disease alone or by other associated factors; 3) whether a geriatric specialist intervention to evaluate and correct other diseases with their potential or already evident disabilities can improve the results of TAVI, in particular patient quality of life. Consequently, in addition to risk stratification with conventional tools, a number of factors including multimorbidity, disability, frailty and cognitive function should be considered in order to assess the expected benefit of TAVI. Preoperative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, renal) that can potentially worsen the reduced physiological reserves characteristic of frailty. The systematic implementation into clinical practice of multidimensional assessment instruments of frailty and cognitive function for screening and exercise, and the adoption of specific care pathways should facilitate this task.
Editor: Italy
Idioma: Italiano

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ANMCO/SIC/SICI-GISE/SICCH Consensus document: Risk stratification in elderly patients undergoing cardiac surgery and transcatheter aortic valve implantation

Italy

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