Incidence and predictors of activities of daily living decline after transcatheter aortic valve implantation.

PURPOSE: To clarify the incidence of activities of daily living (ADL) decline following transcatheter aortic valve implantation (TAVI) and to investigate its contributing factors, including anesthesia methods and sedative drugs.

METHODS

This retrospective study included 128 patients who underwent transfemoral TAVI between December 2018 and June 2023. ADL was assessed using the Katz Index preoperatively and one week postoperatively. Patients with decreased scores were assigned to the ADL-decline group. Clinical, physical, cognitive, and perioperative data were analyzed. Multivariate logistic regression analysis was performed to identify predictors of ADL decline.

RESULTS

ADL decline occurred in 25 patients (20%), who were significantly older (87.9 vs. 85.1 years, p = 0.004), had lower preoperative Short Physical Performance Battery (SPPB) scores (7.2 vs. 9.7, p = 0.001), and lower preoperative grip strength (14.6 vs. 17.4, p = 0.04). All three patients of with postoperative cerebral infarction experienced ADL decline. No significant differences in anesthesia methods (general anesthesia vs. monitored anesthesia care) or sedative drugs (propofol vs. remimazolam) were noted. Multivariate analysis revealed that older age (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.01-1.31; p = 0.03) and lower preoperative SPPB score (adjusted OR: 0.83; 95% CI: 0.69-0.98; p = 0.03) were independent predictors of ADL decline.

CONCLUSION

Older age and reduced preoperative physical function were associated with ADL decline after TAVI. In contrast, anesthesia methods and sedative drug choices did not influence postoperative ADL. These findings may help guide patient selection and inform perioperative rehabilitation strategies to preserve independence after TAVI.