Dysexecutive mild cognitive impairment does not impact outcomes one year after a TAVR procedure in older patients

Résumé fourni par la source

Many geriatric syndromes are associated with poor prognosis after transcatheter aortic valve replacement (TAVR) in patients aged 75 and older. But none has yet focused on patients with mild cognitive impairment (MCI), especially dysexecutive MCI (d-MCI). The main objective was to evaluate the impact of d-MCI on death or hospitalisation one year after a TAVR procedure. All patients aged > 75 with a normal Katz and Lawton's instrumental activities of daily living index referred for a TAVR between 2012 and 2018 at the Nantes University Hospital were included. Dysexecutive syndrome was defined by a frontal assessment battery (FAB) under 16. One-year mortality and hospitalisation were recorded. A multivariable analysis was conducted to analyse the prognostic value of d-MCI. Among the 494 patients included (median age=85), 18% were hospitalised or died in the first year after the TAVR procedure. In a multivariable logistic regression model, only the Charlson comorbidity index [OR=1.36, 95% CI (1.20-1.56), p<0.001], the mean aortic transvalvular pressure gradient [OR=0.98, 95% CI (0.97-1.00), p=0.04] and a history of chronic respiratory failure (CRF) [OR=1.98, 95% CI (1.03-3.8), p=0.04] were significantly associated with poor outcomes. There was no association between d-MCI and rehospitalisation or death 1 year after a TAVR procedure. However, this study confirmed the prognostic importance of Charlson comorbidity index and mean aortic transvalvular pressure gradient before TAVR.

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