Periprocedural care for frail older patients with aortic stenosis undergoing transcatheter aortic valve replacement

Abstract

Degenerative aortic stenosis (AS) is an aging-associated disease with alarmingly high mortality that has risen in prevalence in tandem with the global population aging. Treatment options for AS are currently limited to surgical or percutaneous valve intervention, which are associated with significant morbidity. It is increasingly recognized that the care of AS patients is frequently constrained by concomitant frailty, an under-recognized syndrome among older individuals. Many AS patients have concurrent aging-associated diseases, including atherosclerotic diseases, organ impairment, physical frailty, and nutritional deficiencies which limit functional improvement after valve intervention. It has become increasingly crucial for clinicians to address these concurrent issues in frail, older individuals with AS to achieve the best possible outcomes. We aim to review the well-studied relationship between frailty and AS, as well as possible strategies for periprocedural optimization and risk management.