plicazioni per la medicina geriatrica, che si trova e si troverà sempre
più spesso a doversi confrontare con questi pazienti e con le difficili
scelte terapeutiche che la patologia presenta. Peraltro i geriatri hanno
anche l’opportunità di diventare il medico cardine della valutazione
preoperatoria di questi pazienti, essendo in grado di valutarne tutti gli
aspetti, al di la della semplice valutazione ecocardiografica e clinica
standard, spesso non dirimente.
BiBliografia
1 Lindroos M, Kupari M, Heikkila J, et al. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J
Am CollCardiol 1993;21:1220-5.
2 Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur
3 Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet 2006;368:1005-11.
4 Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardio- vascular Angiography and Interventions, and Society of Thoracic Surgeons.
Circulation 2008;118:e523-661.
5 Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J
Am CollCardiol 2006;47:2141-51.
6 Svensson LG, Blackstone EH, Cosgrove DM, 3rd. Surgical options in young adults with aortic valve disease. Curr Probl Cardiol 2003;28:417-80.
7 Vahanian A, Alfieri O, Al-Attar N, et al. Transcatheter valve implantation for pa- tients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2008;29:1463-70.
8 Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case descrip- tion. Circulation 2002;106:3006-8.
9 Cribier A, Eltchaninoff H, Tron C, Bauer F, et al. Early experience with percutane- ous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol
2004;43:698-703.
10 Piazza N, Grube E, Gerckens U, et al. Procedural and 30-day outcomes follow- ing transcatheter aortic valve implantation using the third generation (18 Fr) corevalverevalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. Euro Intervention 2008;4:242-9. 11 Thomas M, Schymik G, Walther T, et al. Thirty-day results of the SAPIEN aorticBio-
prosthesis European Outcome (SOURCE) Registry: A European registry of trans- catheter aortic valve implantation using the Edwards SAPIEN valve. Circulation
2010;122:62-9.
12 Wendler O, Walther T, Nataf P, et al. Trans-apical aortic valve implantation: uni- variate and multivariate analyses of the early results from the SOURCE registry.
Eur J Cardiothorac Surg 2010;38:119-27.
13 Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med
2010;363:1597-607.
14 Webb JG, Pasupati S, Humphries K, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation
2007;116:755-63.
15 Ye J, Cheung A, Lichtenstein SV, et al. Six-month outcome of transapicaltranscath- eter aortic valve implantation in the initial seven patients. Eur J Cardiothorac
Surg 2007;31:16-21.
16 Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multi- dimensional prognostic index for one-year mortality from comprehensive geri- atric assessment in hospitalized older patients. Rejuvenation Res 2008;11:151-61. 17 Abellan van Kan G, Rolland Y, Houles M, et al. The assessment of frailty in older
adults. Clin Geriatr Med 2010;26:275-86.
18 Abellan van Kan G, Rolland Y, Bergman H, et al. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008;12:29-37. 19 Afilalo J. Frailty in Patients with Cardiovascular Disease: Why, When, and How
to Measure. Curr Cardiovasc Risk Rep 2011;5:467-72.
20 Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv 2012;5:974-81. 21 Green P, Woglom AE, Genereux P, et al. Gait speed and dependence in activities of
daily living in older adults with severe aortic stenosis. Clin Cardiol 2012;35:307-
14.
22 Stortecky S, Schoenenberger AW, Moser A, et al. Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. JACC Cardiovasc Interv2012;5:489-96. 23 Rodes-Cabau J, Mok M. Working toward a frailty index in transcatheter aortic
valve replacement: a major move away from the “eyeball test”. JACC Cardiovasc
Interv 2012;5:982-3.
24 Siqueira D, Abizaid A, Arrais M, et al. Transcatheter aortic valve replacement in elderly patients. J Geriatr Cardiol 2012;9:78-82.
25 Schoenenberger AW, Stortecky S, Neumann S, et al. Predictors of functional de- cline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). Eur Heart J 2013;34:684-92.
26 Pilotto A, Rengo F, Marchionni N, et al. Comparing the prognostic accuracy for
all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients. PLoS One 2012;7:e29090.
27 Katz S, Ford AB, Moskowitz RW, et al. Studies of Illness in the Aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function. JAMA
1963;185:914-9.
28 Lawton MP, Brody EM. Assessment of older people: self-maintaining and instru- mental activities of daily living. Gerontologist 1969;9:179-86.
29 Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc1975;23:433-41. 30 Bliss MR, McLaren R, Exton-Smith AN. Mattresses for preventing pressure sores in
geriatric patients. Mon Bull Minist Health Public Health Lab Serv 1966;25:238-68. 31 Conwell Y, Forbes NT, Cox C, et al. Validation of a measure of physical illness bur-
den at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc 1993;41:38-
41.
32 Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999;15:116-22. 33 Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:85-94. 34 Di Bari M, Balzi D, Roberts AT, et al. Prognostic stratification of older persons based on simple administrative data: development and validation of the “Silver Code”, to be used in emergency department triage. J Gerontol A Biol Sci Med Sci
2010;65:159-64.
35 Gotzmann M, Pljakic A, Bojara W, et al. Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis-predictors of mortality and poor treatment response. Am Heart J 2011;162:238-45.
36 Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of val- vular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J
2012;33:2451-96.
37 Freed BH, Sugeng L, Furlong K, et al. Reasons for nonadherence to guidelines for aortic valve replacement inpatients with severe aortic stenosis and potential solutions. Am J Cardiol 2010;105:1339-42.
38 Pibarot P, Dumesnil JG. Improving assessment of aortic stenosis. J Am Coll Cardiol
2012;60:169-80.
39 van G MWA. New trends and developments in patients with severe aortic stenosis - towards optimal treatment? Eur Cardiol 2009;5:81-4.
40 Ungar A, Bramlage P, Thoenes M, et al. A call to action – Geriatricians’ experience in treatment of aortic stenosis and involvement in transcatheter aortic valve implantation. European Geriatric Medicine 2013;4:176-82.
41 Ungar A, Schoenenberger A, Maggi S, et al. The value of comprehensive geriatric assessment in elderly patients with severe aortic stenosis – a position statement of the European Union Geriatric Medicine Society (EUGMS). European Geriatric
Medicine 2015;6:271-3.
42 Schoenenberger AW, Werner N, Bramlage P, et al. Ungar. Comprehensive geriatric
Fig. 1. Risultati in termini di Classe NYHA in 57 pazienti ottuagenari sottoposti
a TAVI per stenosi aortica severa. Risultati preliminari dello studio CG-TAVI della EUGMS 42
assessment in patients undergoing transcatheter aortic valve implantation– rationale and design of the European CGA-TAVI registry. European Geriatric
Medicine 2014;5:8-13.