Original Studies The Impact of Frailty Status on Clinical and Functional Outcomes After Transcatheter Aortic Valve Replacement in Nonagenarians With Severe Aortic Stenosis Alexis K. Okoh, * MD , Dhaval Chauhan, MD , Nathan Kang, MS, Nicky Haik, BA, Aurelie Merlo, BA, Mark Cohen, MD, Bruce Haik, MD, Chunguang Chen, MD, and Mark J. Russo., MD, MS Background: The impact of frailty status on TAVR outcomes in nonagenarians is unknown. The present study aims to investigate the impact of frailty status on procedural outcomes and overall survival in nonagenarians after TAVR. Methods: A frailty score (FS) was derived by using preoperative grip strength, gait speed, serum albumin, and daily activities. Patients were divided into two groups: Frail (FS  3/4) and Non-Frail (FS <3/4). Health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ). Baseline demographic and clinical characteristics were compared in both groups. The effect of frailty status on outcomes was investigated. Cox regression analy- ses were performed to determine predictors of overall all-cause mortality. Kaplan-Meier survival curves were used to estimate survival. Results: Seventy-five patients >90 years underwent full assessment for frailty status. There was a significant improvement in over- all health status of non-frail patients (mean difference: 11.03, P 5 0.032). Unadjusted 30- day and 2-year mortality rates were higher in the frail group than the non-frail group. (14% vs. 2% P 5 0.059; 31% vs. 9% P 5 0.018). Kaplan-Meier estimated all-cause mortality to be significantly higher in the frail group (log-rank test; P 5 0.042). Frailty status was inde- pendently associated with increased mortality (hazard ratio: 1.84, 95% C.I: 1.06–3.17; P 5 0.028) after TAVR. Conclusion: Among nonagenarians selected to undergo TAVR for severe aortic stenosis, a considerable number are frail. Nonfrail patients report a signifi- cant improvement in overall health status in the short term. Worse frailty is strongly asso- ciated with diminished long-term survival. VC 2017 Wiley Periodicals, Inc. Key words: transcatheter aortic valve replacement; TAVI; nonagenarians; frailty; aortic valve stenosis INTRODUCTION There is overwhelming evidence to support the use of transcatheter aortic valve replacement (TAVR) in the treatment of aortic stenosis (AS) in patient consid- ered high risk [1]. This is true regardless of age, as previous authors have demonstrated the safety and effi- cacy of TAVR in nonagenarians [2]. Emerging clinical evidence has suggested that a pro- portion of patients have little or no benefit after TAVR and this has been associated with several factors including composite comorbidities, extremely high mortality risk, and frailty status [3–5]. Frailty has been associated with worse survival in AS patients undergo- ing TAVR and strongly correlated with procedural Department of Cardiothoracic Surgery, RWJ Barnabas Health- Newark Beth Israel Medical Center, Newark, New Jersey Conflict of interest: All authors have no conflict of interest to declare. *Correspondence to: Alexis K. Okoh, Department of Cardiothoracic Surgery, RWJ Barnabas Health-Newark Beth Israel Medical Center. 201 Lyons Avenue, Suite G5. Newark, NJ. E-mail: disciple951@ gmail.com Received 6 January 2017; Revision accepted 25 March 2017 DOI: 10.1002/ccd.27083 Published online 00 Month 2017 in Wiley Online Library (wileyonlinelibrary.com) VC 2017 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 00:00–00 (2017)