***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND The use of transcatheter aortic-valve replacement has been shown to reduce mortality among high-risk patients with aortic stenosis who are not c and i date s for surgical replacement . However , the two procedures have not been compared in a r and omized trial involving high-risk patients who are still c and i date s for surgical replacement . METHODS At 25 centers , we r and omly assigned 699 high-risk patients with severe aortic stenosis to undergo either transcatheter aortic-valve replacement with a balloon-exp and able bovine pericardial valve ( either a transfemoral or a transapical approach )  or surgical replacement .  The primary end point was death from any cause at 1 year . The primary hypothesis was that transcatheter replacement is not inferior to surgical replacement . RESULTS The rates of death from any cause were 3.4 % in the transcatheter group and 6.5 % in the surgical group at 30 days ( P=0.07 ) and 24.2 % and 26.8 % , respectively , at 1 year ( P=0.44 ) , a reduction of 2.6 percentage points in the transcatheter group ( upper limit of the 95 % confidence interval , 3.0 percentage points ; predefined margin , 7.5 percentage points ; P=0.001 for noninferiority ) . The rates of major stroke were 3.8 % in the transcatheter group and 2.1 % in the surgical group at 30 days ( P=0.20 ) and 5.1 % and 2.4 % , respectively , at 1 year ( P=0.07 ) . At 30 days , major vascular complications were significantly more frequent with transcatheter replacement ( 11.0 % vs. 3.2 % , P<0.001 ) ; adverse events that were more frequent after surgical replacement included major bleeding ( 9.3 % vs. 19.5 % , P<0.001 ) and new-onset atrial fibrillation ( 8.6 % vs. 16.0 % , P=0.006 ) . More patients undergoing transcatheter replacement had an improvement in symptoms at 30 days , but by 1 year , there was not a significant between-group difference . CONCLUSIONS In high-risk patients with severe aortic stenosis , transcatheter and surgical procedures for aortic-valve replacement were associated with similar rates of survival at 1 year , although there were important differences in periprocedural risks . ( Funded by Edwards Lifesciences ; Clinical Trials.gov number , NCT00530894 . ) Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information BACKGROUND Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure . Frailty is thought to estimate physiologic reserves , although its use has not been evaluated in surgical patients . We design ed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models . STUDY DESIGN We prospect ively measured frailty in 594 patients ( age 65 years or older ) presenting to a university hospital for elective surgery between July 2005 and July 2006 . Frailty was classified using a vali date d scale ( 0 to 5 ) that included weakness , weight loss , exhaustion , low physical activity , and slowed walking speed . Patients scoring 4 to 5 were classified as frail , 2 to 3 were intermediately frail , and 0 to 1 were nonfrail . Main outcomes measures were 30-day surgical complications , length of stay , and discharge disposition . Multiple logistic regression ( complications and discharge ) and negative binomial regression ( length of stay ) were done to analyze frailty and postoperative outcomes associations . RESULTS Preoperative frailty was associated with an increased risk for postoperative complications ( intermediately frail : odds ratio [ OR ] 2.06 ; 95 % CI 1.18 - 3.60 ; frail : OR 2.54 ; 95 % CI 1.12 - 5.77 ) , length of stay ( intermediately frail : incidence rate ratio 1.49 ; 95 % CI 1.24 - 1.80 ; frail : incidence rate ratio 1.69 ; 95 % CI 1.28 - 2.23 ) , and discharge to a skilled or assisted-living facility after previously living at home ( intermediately frail : OR 3.16 ; 95 % CI 1.0 - 9.99 ; frail : OR 20.48 ; 95 % CI 5.54 - 75.68 ) . Frailty improved predictive power ( p < 0.01 ) of each risk index ( ie , American Society of Anesthesiologists , Lee , and Eagle scores ) . CONCLUSIONS Frailty independently predicts postoperative complications , length of stay , and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models . Assessing frailty using a st and ardized definition can help patients and physicians make more informed decisions AIMS Risk scores provide an important contribution to clinical decision-making , but their validity has been question ed in patients with valvular heart disease ( VHD ) , since current scores have been mainly derived and vali date d in adults undergoing coronary bypass surgery . The Working Group on Valvular Heart Disease of the European Society of Cardiology review ed the performance of currently available scores when applied to VHD , in order to guide clinical practice and future development of new scores . METHODS AND RESULTS The most widely used risk scores ( EuroSCORE , STS , and Ambler score ) were review ed , analysing variables included and their predictive ability when applied to patients with VHD . These scores provide relatively good discrimination , i.e. a gross estimation of risk category , but can not be used to estimate the exact operative mortality in an individual patient because of unsatisfactory calibration . CONCLUSION Current risk scores do not provide a reliable estimate of exact operative mortality in an individual patient with VHD . They should therefore be interpreted with caution and only used as part of an integrated approach , which incorporates other patient characteristics , the clinical context , and local outcome data . Future risk scores should include additional variables , such as cognitive and functional capacity and be prospect ively vali date d in high-risk patients . Specific risk models should also be developed for newer interventions , such as transcatheter aortic valve implantation Background For selected patients with symptomatic aortic stenosis , transcatheter aortic valve implantation ( TAVI ) is an alternative to surgical aortic valve replacement ( AVR ) . In addition to co-morbidities , frailty has to be taken into account in the decision-making process . Criteria for patient selection , according to current guidelines , include EuroSCORE and STS score but frailty is not easy to quantify . ISAR ( Identifi cation of Seniors At Risk ) detects seniors at risk for adverse health outcome after an emergency visit and SHERPA ( Score Hospitalier d’Evaluation du Risque de Perte d’Autonomie ) assesses the risk of functional decline after hospitalization . Objectives The aim of the present study was to evaluate the impact of ISAR and SHERPA scores in the prediction of patient outcome after TAVI . Methods and results A prospect i ve cohort of 30 consecutive octogenarian patients ( 16 males , 86 ± 3 y , EuroSCORE 34 ± 12 % ) underwent a transfemoral TAVI and a complete geriatric assessment in our institution . Survival at one year was 73 % . The ISAR score was similar between both groups ( 3.1 ± 1 vs. 3.6 ± 1 ; P = 0.10 ) but the SHERPA score was signifi cantly higher in non-survivors ( 7.8 ± 1.6 ) than among survivors ( 4.9 ± 2.4 ; P = 0.001 ) . With multivariate analysis , SHERPA score and BMI were independent predictors of 1-year mortality . Kaplan-Meier analysis showed that 1-year survival was signifi cantly lower in patients with than in those without a SHERPA score > 7 ( 40 vs. 89 % ; P = 0.004 ) . Conclusions The result of this study showed that SHERPA score predicts 1-year survival  after transfemoral TAVI and could be considered as a useful frailty score in patient selection BACKGROUND Transcatheter aortic-valve implantation ( TAVI ) is an emerging intervention for the treatment of high-risk patients with severe aortic stenosis and coexisting illnesses . We report the results of a prospect i ve multicenter study of the French national transcatheter aortic-valve implantation registry , FRANCE 2 . METHODS All TAVIs performed in France , as listed in the FRANCE 2 registry , were prospect ively included in the study . The primary end point was death from any cause . RESULTS A total of 3195 patients were enrolled between January 2010 and October 2011 at 34 centers . The mean ( ±SD ) age was 82.7±7.2 years ; 49 % of the patients were women . All patients were highly symptomatic and were at high surgical risk for aortic-valve replacement .  Edwards SAPIEN and Medtronic CoreValve devices were implanted in 66.9 % and 33.1 % of patients , respectively . Approaches were either transarterial ( transfemoral , 74.6 % ; subclavian , 5.8 % ; and other , 1.8 % ) or transapical ( 17.8 % ) . The procedural success rate was 96.9 % . Rates of death at 30 days and 1 year were 9.7 % and 24.0 % , respectively . At 1 year , the incidence of stroke was 4.1 % , and the incidence of periprosthetic aortic regurgitation was 64.5 % . In a multivariate model , a higher logistic risk score on the European System for Cardiac Operative Risk Evaluation ( EuroSCORE ) , New York Heart Association functional class III or IV symptoms , the use of a transapical TAVI approach , and a higher amount of periprosthetic regurgitation were significantly associated with reduced survival . CONCLUSIONS This prospect i ve registry study reflected real-life TAVI experience in high-risk elderly patients with aortic stenosis , in whom TAVI appeared to be a reasonable option . ( Funded by Edwards Lifesciences and Medtronic . ) OBJECTIVES The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation ( TAVI )  , regardless of technology or access route , and to evaluate their clinical outcome over the mid to long term . BACKGROUND Although a substantial body of data exists in relation to early clinical outcomes after TAVI , there are few data on outcomes beyond 1 year in any notable number of patients . METHODS The U.K. TAVI ( United Kingdom Transcatheter Aortic Valve Implantation ) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom . Data were collected prospect ively on 870 patients undergoing 877 TAVI procedures up until December 31 , 2009 . Mortality tracking was achieved in 100 % of patients with mortality status reported as of December 2010 . RESULTS Survival at 30 days was 92.9 % , and it was 78.6 % and 73.7 % at 1 year and 2 years , respectively . There was a marked attrition in survival between 30 days and 1 year . In a univariate model , survival was significantly adversely affected by renal dysfunction , the presence of coronary artery disease , and a nontransfemoral approach ; whereas left ventricular function ( ejection fraction < 30 % ) , the presence of moderate/severe aortic regurgitation , and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model . CONCLUSIONS Midterm to long-term survival after TAVI was encouraging in this high-risk patient population , although a substantial proportion of patients died within the first year OBJECTIVES This study evaluated  Multidimensional Geriatric Assessment ( 
    Output:
    
Conclusion Frailty assessment in an already vulnerable TAVI population identifies individuals at even greater risk of poor outcomes .