Aortic stenosis in the frail patient: Maximizing the benefit of TAVI

Transcatheter aortic valve implantation (TAVI) is an increasingly common intervention for older patients with aortic stenosis deemed at high risk of complications from major cardiac surgery, but identifying those who will benefit can be challenging. Frailty, as a measure of physiological reserve, may be a useful prognostic marker in this population. In this brief review, we summarize the frailty tools that have been studied in TAVI cohorts and the reported outcomes for these patients. Frailty is associated with poorer outcomes after TAVI and assessment provides information beyond conventional surgical risk calculators, such as from the Society of Thoracic Surgeons (STS) and EuroSCORE. Of more use to the clinician is understanding that objective and reproducible physical frailty measures can identify patients at the very highest risk of early mortality or worsening disability after TAVI. Using these tools to help assess risk in older patients with aortic stenosis and guide patient selection for TAVI has great potential to maximize the benefit of treatment.