FRAGILIDAD COMO PREDICTOR DE RESULTADOS PERIOPERATORIOS Y A LARGO PLAZO TRAS EL REEMPLAZO VALVULAR AÓRTICO QUIRÚRGICO Y TRANSCATÉTER EN ADULTOS MAYORES
Authors/Creators
- 1. Centro de Salud Tipo A Quichinche. Imbabura, Ecuador.
- 2. Pontificia Universidad Católica del Ecuador. Santo Domingo de los Tsáchilas, Ecuador.
- 3. Centro de Salud Tipo A Huachi Grande. Tungurahua, Ecuador.
- 4. Servicios Médicos Cumandá. Tungurahua, Ecuador.
- 5. Pontificia Universidad Católica del Ecuador – Hospital de la Policía Nacional N.º 1. Quito, Ecuador.
Description
Tipo de artículo: Artículo de revisión
Antecedentes: La fragilidad constituye un síndrome geriátrico asociado a la disminución de la reserva fisiológica y a una mayor vulnerabilidad ante el estrés quirúrgico. En adultos mayores con estenosis aórtica grave, su presencia adquiere relevancia pronóstica en el reemplazo valvular.
Objetivo: Analizar la asociación entre fragilidad y desenlaces perioperatorios y a largo plazo en adultos mayores sometidos a reemplazo valvular aórtico quirúrgico o transcatéter.
Método: Se realizó una revisión bibliográfica estructurada en las bases de datos PubMed/MEDLINE, Scopus, Web of Science y Embase, considerando publicaciones entre 2021 y 2026 relacionadas con fragilidad, estenosis de la válvula aórtica, reemplazo valvular aórtico quirúrgico o transcatéter y desenlaces clínicos. Se incluyeron publicaciones en idioma español e inglés correspondientes a metaanálisis, ensayos clínicos, estudios observacionales y guías de práctica clínica.
Resultados: La fragilidad se asocia con un incremento de la mortalidad perioperatoria, complicaciones cardiovasculares, delirium y estancias hospitalarias prolongadas tras el reemplazo valvular aórtico. La evaluación de la fragilidad constituye una herramienta pronóstica complementaria a los modelos convencionales de riesgo quirúrgico. A pesar de la menor agresión fisiológica asociada al reemplazo valvular aórtico transcatéter, la fragilidad continúa relacionándose con desenlaces clínicos desfavorables independientemente de la estrategia terapéutica utilizada.
Conclusión: La fragilidad es un predictor independiente de desenlaces adversos en adultos mayores sometidos a reemplazo valvular aórtico. Su evaluación estructurada mejora la estratificación pronóstica y favorece una toma de decisiones individualizada mediante la valoración geriátrica integral y el abordaje multidisciplinario.
Abstract (English)
Article type: Review article
Background: Frailty constitutes a geriatric syndrome associated with reduced physiological reserve and increased vulnerability to surgical stress. In older adults with severe aortic stenosis, its presence has significant prognostic implications in both surgical and transcatheter aortic valve replacement procedures.
Objective: To analyse the association between frailty and perioperative as well as long-term outcomes in older adults undergoing surgical aortic valve replacement or transcatheter aortic valve implantation.
Method: A structured literature review was conducted using the PubMed/MEDLINE, Scopus, Web of Science, and Embase databases, considering publications between 2021 and 2026 related to frailty, aortic valve stenosis, surgical aortic valve replacement, transcatheter aortic valve implantation, and clinical outcomes. Publications in English and Spanish, including meta-analyses, clinical trials, observational studies, and clinical practice guidelines, were included.
Results: Frailty is associated with increased perioperative mortality, cardiovascular complications, delirium, and prolonged hospital stay following aortic valve replacement. Frailty assessment represents a prognostic tool complementary to conventional surgical risk models. Despite the lower physiological burden associated with transcatheter aortic valve implantation, frailty remains associated with unfavourable clinical outcomes regardless of the therapeutic strategy employed.
Conclusion: Frailty is an independent predictor of adverse outcomes in older adults undergoing aortic valve replacement. Its structured assessment improves prognostic stratification and supports individualised decision-making through comprehensive geriatric assessment and a multidisciplinary approach.
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Additional details
Additional titles
- Translated title (English)
- FRAILTY AS A PREDICTOR OF PERIOPERATIVE AND LONG-TERM OUTCOMES FOLLOWING SURGICAL AND TRANSCATHETER AORTIC VALVE REPLACEMENT IN OLDER ADULTS
Dates
- Collected
-
2026-05-14manuscrito recibido
- Accepted
-
2026-06-20evaluación doble ciego
- Available
-
2026-07-29publicación en el número de la revista
Software
- Repository URL
- https://revistacientificasanum.com/
References
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