Transcatheter Aortic Valve Implantation in Nonagenarians: Procedural Outcome and Mid-term Results

• Published in: Heart, lung & circulation lung & circulation, 2018-06, Vol.27 (6), p.725-730
• Main Authors: Scholtz, Smita, MD, Dimitriadis, Zisis, MD, Vlachojannis, Marios, MD, Piper, Cornelia, MD, PhD, Horstkotte, Dieter, MD, PhD, Wiemer, Marcus, MD, PhD, Gummert, Jan, MD, PhD, Fujita, Buntaro, MD, Benzinger, Michael, MD, Ensminger, Stephan M., MD, PhD, Börgermann, Jochen, MD, PhD, Scholtz, Werner, MD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged, 80 and over; Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiovascular; Coronary Angiography; Echocardiography; Female; Follow-Up Studies; Germany - epidemiology; Humans; Male; Multidetector Computed Tomography - methods; Nonagenarians; Prognosis; Prosthesis Design; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Rate - trends; TAVI; Time Factors; Transcatheter Aortic Valve Replacement - methods
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2017.05.137

Background For nonagenarians with symptomatic severe aortic stenosis transcatheter aortic valve implantation (TAVI) has become a feasible therapeutic option. Therefore, the aim of this study was to evaluate the procedural outcomes and mid-term follow-up in this patient group and compare this to octogenarians. Methods From 1359 patients who underwent TAVI at our institution between March 2009 and February 2016, 82 patients were nonagenarians and 912 were octogenarians. In nonagenarians, mean age was 91.9 ± 1.4 years and compared to octogenarians showed a significantly higher logistic EuroScore (27.7 ± 14.8% vs. 23.1 ± 14.4, p = 0.005) and STS Score (8.5 ± 4.8% vs. 6.3 ± 6.7, p = 0.001). Results There were no significant differences with regard to stroke rate, pacemaker implantation rate and major vascular complications between the two groups. Thirty-day mortality was 9.8% in nonagenarians and 4.1% in octogenarians (p = 0.04). At one year, all-cause mortality increased to 30.9% vs. 18.6% (n.s.). Conclusion Nonagenarians showed an increased periprocedural mortality during TAVI and higher mortality in follow-up compared to octogenarians. Age alone is not a predictive factor but indication for treatment should be carefully evaluated by the heart team on an individual basis.