***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores . BACKGROUND European System for Cardiac Operative Risk Evaluation ( EuroSCORE ) or Society of Thoracic Surgeons ( STS ) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement ( TAVR ) . METHODS This prospect i ve cohort comprised 330 consecutive TAVR patients ≥70 years of age .  Conventional scores and a frailty index ( based on assessment of cognition , mobility , nutrition , and activities of daily living ) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression ( providing hazard ratios [ HRs ] with confidence intervals [ CIs ] ) and measures of test performance ( providing likelihood ratio [ LR ] chi-square test statistic and C-statistic [ CS ] ) . RESULTS All risk scores were predictive of the outcome ( EuroSCORE , HR : 1.90 [ 95 % CI : 1.45 to 2.48 ] , LR chi-square test statistic 19.29 , C-statistic 0.67 ; STS score , HR : 1.51 [ 95 % CI : 1.21 to 1.88 ] , LR chi-square test statistic 11.05 , C-statistic 0.64 ; frailty index , HR : 3.29 [ 95 % CI : 1.98 to 5.47 ] , LR chi-square test statistic 22.28 , C-statistic 0.66 ) . A combination of the frailty index with either EuroSCORE ( LR chi-square test statistic 38.27 , C-statistic 0.72 ) or STS score ( LR chi-square test statistic 28.71 , C-statistic 0.68 ) improved mortality prediction . The frailty index accounted for 58.2 % and 77.6 % of the predictive information in the combined model with EuroSCORE and STS score , respectively . Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction . CONCLUSIONS This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement Aims This study aim ed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation ( TAVI )  and to find predictors of functional decline . Methods and results In this prospect i ve cohort , functional course was assessed in patients ≥70 years using basic activities of daily living ( BADL ) before and 6 months after TAVI .  Baseline EuroSCORE , STS score , and a frailty index ( based on assessment of cognition , mobility , nutrition , instrumental and basic activities of daily living ) were evaluated to predict functional decline ( deterioration in BADL ) using logistic regression models . Functional decline was observed in 22 ( 20.8 % ) of 106 surviving patients .  EuroSCORE ( OR per 10 % increase 1.18 , 95 % CI : 0.83 - 1.68 , P = 0.35 ) and STS score ( OR per 5 % increase 1.64 , 95 % CI : 0.87 - 3.09 , P = 0.13 ) weakly predicted functional decline . In contrast , the frailty index strongly predicted functional decline in univariable ( OR per 1 point increase 1.57 , 95 % CI : 1.20 - 2.05 , P = 0.001 ) and bivariable analyses ( OR : 1.56 , 95 % CI : 1.20 - 2.04 , P = 0.001 controlled for EuroSCORE ; OR : 1.53 , 95 % CI : 1.17 - 2.02 , P = 0.002 controlled for STS score ) . Overall predictive performance was best for the frailty index [ Nagelkerke 's R(2 ) ( NR(2 ) ) 0.135 ] and low for the EuroSCORE ( NR(2 ) 0.015 ) and STS score ( NR(2 ) 0.034 ) . In univariable analyses , all components of the frailty index contributed to the prediction of functional decline . Conclusion Over a 6-month period , functional status worsened only in a minority of patients surviving TAVI . The frailty index , but not established risk scores , was predictive of functional decline . Refinement of this index might help to identify patients who potentially benefit from additional geriatric interventions after TAVI OBJECTIVES This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement ( TAVR ) for symptomatic aortic stenosis . BACKGROUND Frailty status impacts prognosis in older adults with heart disease ; however , the impact of frailty on prognosis after TAVR is unknown . METHODS Gait speed , grip strength , serum albumin , and activities of daily living status were collected at baseline and used to derive a frailty score  among patients who underwent TAVR procedures at a single large-volume institution . The cohort was dichotomized on the basis of median frailty score into frail and not frail groups . The impact of frailty on procedural outcomes ( stroke , bleeding , vascular complications , acute kidney injury , and mortality at 30 days ) and 1-year mortality was evaluated . RESULTS Frailty status was assessed in 159 subjects who underwent TAVR ( age 86 ± 8 years , Society of Thoracic Surgery Risk Score 12 ± 4 ) .  Baseline frailty score was not associated with conventionally ascertained clinical variables or Society of Thoracic Surgery score . Although high frailty score was associated with a longer post-TAVR hospital stay when compared with lower frailty score ( 9 ± 6 days vs. 6 ± 5 days , respectively , p = 0.004 ) , there were no significant crude associations between frailty status and procedural outcomes , suggesting adequacy of the st and ard selection process for identifying patients at risk for periprocedural complications after TAVR . Frailty status was independently associated with increased 1-year mortality ( hazard ratio : 3.5 , 95 % confidence interval : 1.4 to 8.5 , p = 0.007 ) after TAVR . CONCLUSIONS Frailty was not associated with increased periprocedural complications in patients selected as c and i date s to undergo TAVR but was associated with increased 1-year mortality after TAVR . Further studies will evaluate the independent value of this frailty composite in older adults with aortic stenosis OBJECTIVES This study evaluated  Multidimensional Geriatric Assessment ( MGA ) as predictor of mortality and major adverse cardiovascular and cerebral events ( MACCE ) after  transcatheter aortic valve implantation ( TAVI ) .  BACKGROUND Currently used global risk scores do not reliably estimate mortality and MACCE in these patients . METHODS This prospect i ve cohort comprised 100 consecutive patients ≥ 70 years undergoing TAVI .  Global risk scores ( Society of Thoracic Surgeons [ STS ] score , EuroSCORE ) and MGA-based scores ( cognition , nutrition , mobility , activities of daily living [ ADL ] , and frailty index ) were evaluated as predictors of all-cause mortality and MACCE 30 days and 1 year after TAVI in regression models . RESULTS In univariable analyses , all predictors were significantly associated with mortality and MACCE at 30 days and 1 year , except for the EuroSCORE at 30 days and instrumental ADL at 30 days and 1 year . Associations of cognitive impairment ( odds ratio [ OR ] : 2.98 , 95 % confidence interval [ CI ] : 1.07 to 8.31 ) , malnutrition ( OR : 6.72 , 95 % CI : 2.04 to 22.17 ) , mobility impairment ( OR : 6.65 , 95 % CI : 2.15 to 20.52 ) , limitations in basic ADL ( OR : 3.63 , 95 % CI : 1.29 to 10.23 ) , and frailty index ( OR : 3.68 , 95 % CI : 1.21 to 11.19 ) with 1-year mortality were similar compared with STS score ( OR : 5.47 , 95 % CI : 1.48 to 20.22 ) and EuroSCORE ( OR : 4.02 , 95 % CI : 0.86 to 18.70 ) . Similar results were found for 30-day mortality and MACCE . Bivariable analyses , including STS score or EuroSCORE suggested independent associations of MGA-based scores ( e.g. , OR of frailty index : 3.29 , 95 % CI : 1.06 to 10.15 , for 1-year mortality in a model including EuroSCORE ) . CONCLUSIONS This study provides evidence that risk prediction can be improved by adding MGA-based information to global risk scores . Larger studies are needed for the development and validation of improved risk prediction models BACKGROUND Percutaneous aortic valve replacement ( PAVR ) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation ( EuroSCOREs ) , patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery .  It is , however , uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients . We evaluated EuroSCORE prediction vs a single institution 's surgical results in this target population . METHODS From January 1996 through March 2006 , 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR .  In this cohort , 313 ( 42.8 % ) were septuagenarians , 322 ( 44.0 % ) were octogenarians or nonagenarians , 233 ( 31.9 % ) had had previous cardiac procedures , 237 ( 32.4 % ) had atheromatous aortas , and 127 ( 17.4 % ) had cerebrovascular disease . A minimally invasive approach was used in 469 ( 64.2 % ) . Data collection was prospect i ve . Long-term survival was computed from the Social Security Death Benefit Index . RESULTS The mean EuroSCORE was 9.7 ( median , 10 ) , and the mean logistic EuroSCORE was 17.2 % . Actual hospital mortality was 7.8 % ( 57 of 731 ) . Multivariate analysis showed ejection fraction of less than 0.30 ( p = 0.002 ; odds ratio [ OR ] , 3.13 ) , chronic obstructive pulmonary disease ( p = 0.019 ; OR , 2.14 ) , and peripheral vascular disease ( p = 0.048 ; OR , 2.13 ) were significant predictors of hospital mortality . Complication(s ) occurred in 73 patients ( 9.9 % ) . Freedom from all-cause death ( including hospital mortality ) was 72.4 % at 5 years ( n = 152 ) . Age ( p < 0.001 ) , previous cardiac operations ( p < 0.014 ; OR , 1.51 ) , renal failure ( p < 0.002 ; OR , 2.37 ) , and chronic obstructive pulmonary disease ( p < 0.007 ; OR , 1.30 ) were predictors of worse survival . CONCLUSIONS Logistic EuroSCORE greatly overpredicts mortality in these patients . Five-year survival is good , unlike suggestions from earlier EuroSCORE analyses . This raises concern about unknown long-term percutaneous prosthesis function . Clinical trials for these patients must include r and omized surgical controls and have long-term end points BACKGROUND Limited data exist on renal complications of  transcatheter aortic valve implantation ( TAVI )  within a comprehensive program using different valves with transfemoral , transapical , and trans-subclavian approach . METHODS Prospect i ve single-center registry of 102 consecutive patients undergoing TAVI using both approved bioprostheses and different access routes . The main objective was to assess the incidence , predictors and the clinical impact of acute kidney injury ( AKI ) . AKI was defined according to the valve academic research consortium ( VARC ) indications . RESULTS Mean age was 83.7 ± 5.3 years , logistic EuroSCORE 22.6 ± 12.4 % , and STS score 8.2 ± 4.1 % . Chronic kidney disease at baseline was present in 87.3 %  . Periprocedural AKI developed in 42 patients ( 41.7 % ) : 32.4 % stage 1 , 4.9 % stage 2 and 3.9 % stage 3 . The incidence of AKI was 66.7 % in transapical , 30.3 % in transfemoral , and 50 % in trans-subclavian procedures . The only independent predictor of AKI was transapical access , with a hazard ratio ( HR ) between 4.57 and 5.18 based on the model used . Cumulative 1-year survival was 88.2 % . At Cox regression analysis , the only independent predictor of 30-day mortality was diabetes mellitus 
    Output:
    
Conclusion : Preoperative frailty status is proved to be significantly associated with poor outcomes after TAVR .