Abstract
Background
Given that life expectancy has improved, nonagenarians have become a significant proportion
of world population. As aortic stenosis is primarily a disease of the elderly, the
need for invasive cardiac approaches is expected to increase in people of extreme
age. Herein, we compare the in-hospital adverse clinical outcomes and mortality after
transcatheter aortic valve implantation (TAVI) procedures in nonagenarians to younger
than 90 year old patients.
Methods
A retrospective study was conducted on 1336 patients who underwent TAVI between January
2016 and March 2020 at Toulouse University Hospital, Rangueil, France. Post-TAVI adverse
clinical outcomes were defined according to Valve Academic Research Consortium-2 Criteria.
The studied population was divided into 2 groups according to age.
Results
Out of 1336 patients, 250 (18.7%) were nonagenarians with a mean age of 91.8 ± 1.9
years. Pacemaker implantation (12.4% vs 12.1%), stroke (2% vs 1.8%), and major vascular
complications (9.2% vs 6.7%) were more common in nonagenarians, whereas acute kidney
injury (1.2% vs 2.7%) and major bleeding events (3.2% vs 3.4%) were more common in
the <90-year-old group. Nonagenarians are more likely to develop major vascular complications
(odds ratio [OR] = 1.76 95% confidence interval [CI] 1.04-3, P = .03). The prevalence of in-hospital mortality in nonagenarians and <90-year-old
patients were 5.2% and 2%, respectively. Survival analysis showed a significant difference
in mortality during hospitalization period only ( P = .04).
Conclusion
The prevalence of TAVI procedural success is remarkably high in nonagenarians and
comparable to that of younger patients. However, the in-hospital mortality rate was
2-fold more than that of <90-year-old patients.
Keywords
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References
- Calcific aortic stenosis : a disease of the valve and the myocardium.J Am Coll Cardiol. 2012; 60: 1854-1863
- Evaluation of mitral and aortic valvular disease and left ventricular dysfunction in a Lebanese population: retrospective single-center experience.Med Sci Monit. 2021; 27e928218
- Outcomes of elderly patients aged 80 and over with symptomatic severe aortic stenosis : impact of patient's choice of refusing aortic valve replacement on survival.QJM. 2008; 101: 567-573
- Transcatheter aortic valve replacement with a balloon-expandable valve in low risk patients.N Engl J Med. 2019; 380: 1695-1705
- 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Col Cardiol. 2007; 135: e1159-e1195
- Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.N Engl J Med. 2010; 363: 1597-1607
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- Registry of transcatheter aortic-valve implantation in high-risk patients.N Engl J Med. 2012; 366: 1705-1715
- Transcatheter aortic-valve replacement with a self-expanding prosthesis.N Engl J Med. 2014; 370: 1790-1798
- Transcatheter aortic valve implantation: first results from a multi-centre real-world registry.Eur Heart J. 2011; 32: 198-204
- Updated standardized endpoint definitions for transcatheter aortic valve implantation.J Am Coll Cardiol. 2012; 60: 1438-1454
- Comparison of effectiveness and safety of transcatheter aortic valve implantation in patients aged≥90 years versus <90 years.Am J Cardiol. 2012; 110: 1156-1163
- Comparison of outcomes of transcatheter aortic valve implantation in patients ≥90 years versus <90 years.Am J Cardiol. 2015; 116: 1110-1115
- Comparison of outcomes of transcatheter aortic valve implantation in patients aged >90years versus <90 years.Am J Cardiol. 2019; 124: 1085-1090
- EurSCORE II.Eur J Cardiothorac Surg. 2012; 41: 734-744
- Operative and middle-term results of cardiac surgery in nonagenarians: a bridge toward routine practice.Circulation. 2010; 121: 208-213
- Nonagenarians undergoing cardiac surgery.J Card Surg. 2014; 29: 600-604
Article Info
Publication History
Published online: March 13, 2022
Footnotes
Funding: Toulouse University Hospital, Rangueil, France.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
