Cardiovascular Revascularization Medicine · Jun 25, 2026

Eyeballing versus comprehensive geriatric frailty assessment and outcomes after transcatheter aortic valve replacement: Insights from a large cohort

By Arow Z, Iwata J, Masumoto A et al.

BACKGROUND: Frailty is common among TAVR candidates. While guidelines recommend formal geriatric assessment for risk stratification, frailty is often evaluated in daily practice using physician judgment - "eyeball test". This study compared outcomes of frail versus non-frail patients undergoing TAVR using frailty classification based on eyeballing or formal geriatric assessment. METHODS: This study included all patients undergoing TAVR for severe aortic stenosis (AS) with balloon-expandable or self-expandable valves between 2012 and 2024. Frailty was assessed in two cohorts: by physician clinical judgment (the "eyeball" cohort) or by formal comprehensive geriatric assessment, which was reserved for cases deemed uncertain by the treating clinician. The primary endpoint was 1-year all-cause mortality. RESULTS: A total of 6343 patients were included in the study. Frailty was assessed by eyeballing in 4603 patients and by comprehensive geriatric assessment in 1740 patients. In the eyeball assessment cohort, frail patients exhibited significantly higher rates of in-hospital mortality (2.1% vs. 1.0%, p = 0.006) and 1-year mortality (8.1% vs. 6.3%, p = 0.024). In the formal geriatric assessment cohort, frail patients demonstrated a numerically higher 1-year mortality rate compared with non-frail patients (7.3% vs. 5.3%); however, this difference did not reach statistical significance (p = 0.160). In both cohorts, there were no significant differences in the composite safety endpoint, PPM implantation, or moderate or greater PVL. CONCLUSION: Frailty assessed by routine clinical "eyeballing" provided prognostic stratification after TAVR. A pragmatic two-step strategy - routine eyeballing with comprehensive geriatric assessment reserved for uncertain cases, may represent an efficient approach for frailty evaluation in contemporary TAVR practice.

doi.org/10.1016/j.carrev.2026.06.016PubMed 42399160Biomarkers