Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients Aged >90 Years Versus <90 Years.
Am J Cardiol
; 124(7): 1085-1090, 2019 10 01.
Article
in En
| MEDLINE
| ID: mdl-31353006
ABSTRACT
Limited data exist regarding transcatheter aortic valve implantation (TAVI) in nonagenarians. This study evaluates the short- and mid-term outcomes of nonagenarians after TAVI. Between 2008 and 2017, all patients who underwent TAVI in 2 centers in Australia were prospectively included in a registry and followed-up for 5 years. Outcomes were based on VARC-2 criteria. Additionally, the patient's reliance on daily living support at 1 year was evaluated. Of the 588 patients, 71 (12.1%) were ≥90 years old (mean age 92.2 ± 2 vs 83.2 ± 6 years in <90-year-old patients), with a median STS-PROM score of 5.7 (vs 3.9 in <90-year-old patients, odds ratio [OR] 1.07, 95% confidence interval 1.01 to 1.13, pâ¯=â¯0.02) and a median clinical frailty score of 4 (vs 4 <90-year-old patients, OR 0.88, pâ¯=â¯0.44). Mortality was 0% in ≥90-year-old patients at 30 days (vs 1.4% in <90-year-old patients; pâ¯=â¯0.82) and 12% at 1 year (vs 7.4%, in <90-year-old patients; hazard ratio 1.64, pâ¯=â¯0.20). There were no significant differences in periprocedural complications and mortality at 5 years between the 2 groups. At 1 year, nonagenarians were significantly more likely to live in an aged-care facility compared with <90-year-old patients (25% vs 16%, OR 5.99, 95% confidence interval 2.62 to 13.67, p <0.001). In conclusion, carefully selected nonagenarians have excellent short- and mid-term outcomes post-TAVI and should therefore not be refused based on age alone. Nevertheless, the significantly higher rate of transfer to an aged-care facility highlights the importance of a more refined frailty assessment before TAVI than the currently widely used clinical frailty score.
Full text:
1
Database:
MEDLINE
Main subject:
Aortic Valve Stenosis
/
Postoperative Complications
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Transcatheter Aortic Valve Replacement
Type of study:
Etiology_studies
/
Incidence_studies
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Observational_studies
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Risk_factors_studies
Limits:
Aged
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Aged80
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Female
/
Humans
/
Male
Country/Region as subject:
Oceania
Language:
En
Year:
2019
Type:
Article