-Surgical risk scores do not include frailty assessments (e.g., gait speed), which are of particular importance for severe aortic stenosis patients considering transcatheter aortic valve replacement (TAVR).
-We assessed the association of 5-meter gait speed with outcomes in a cohort of 8039 patients who underwent TAVR (11/2011-06/2014) and were registered in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry™ (STS/ACC TVT Registry). We evaluated the association between continuous and categorical gait speed and 30-day all-cause mortality before and after adjustment for STS-predicted risk of mortality score and key variables. Secondary outcomes included in-hospital mortality, bleeding, acute kidney injury, and stroke. The median gait speed was 0.63 m/s (0.47-0.79), with the slowest walkers (<0.5 m/s) constituting 28%, slow walkers (0.5 to 0.83 m/s) 48%, and normal walkers (>0.83 m/s) 24% of the population. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4% for slowest, slow, and normal walkers, respectively (p<0.001). Each 0.2 m/s decrease in gait speed corresponded to an 11% increase in 30-day mortality (adjusted odds ratio 1.11, 95% confidence interval 1.01-1.22). The slowest walkers had 35% higher 30-day mortality than normal walkers (adjusted odds ratio 1.35, 95% confidence interval 1.01-1.80), significantly longer hospital stays, and a lower probability of being discharged to home.
-Gait speed is independently associated with 30-day mortality following TAVR. Identification of frail patients with the slowest gait speeds facilitates pre-procedural evaluation and anticipation of a higher level of post-procedural care. Clinical Trial Registration Information-ClinicalTrials.gov. Identifier: NCT01737528.