TAVR in nonagenarians: An analysis investigating safety, efficacy, symptomatic improvement, and long-term survival. Issue 1 (July 2021)

• Record Type: Journal Article
• Authors: Zadrozny, Magda; Hainzer, Nathalie; Mehilli, Julinda; Jochheim, David; Gschwendtner, Sarah; Steffen, Julius; Theiss, Hans; Braun, Daniel; Hagl, Christian; Sadoni, Sebastian; Massberg, Steffen; Hausleiter, Joerg; Deseive, Simon
• Is Part Of: Journal of cardiology. Volume 78:Issue 1(2021)
• Page Start: 44
• Page End: 50
• Publication Date: 2021-07
• Subjects: Transcatheter aortic valve replacement -- Aortic valve stenosis -- Nonagenarian -- 90 years; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2021.01.016
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: Prevalence of relevant aortic stenosis in nonagenarians will constantly increase. Transcatheter aortic valve replacement (TAVR) procedure is safe and feasible in patients aged 90 years or older. 2-year survival of the nonagenarian group was comparable to the general population. TAVR appears to be a reasonable treatment option in carefully selected patients. Abstract: Background: In the aging western societies, an increasing prevalence of severe, symptomatic aortic stenosis is observed. The aim of this study was to examine the safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients aged 90 years and older. Methods: All patients with severe symptomatic aortic stenosis undergoing TAVR at LMU Munich-University-Hospital between 2013 and 2018 were included. Procedure-related mortality (<30 days) was defined as the primary endpoint and survival rates at two years, device failure, and procedural complications were defined as secondary endpoints according to the Valve Academic Research Consortium II criteria. Results and Conclusions: Out of 2336 patients, 2183 were younger than 90 years (<90y.-group) and 153 patients were aged 90 or older (≥90y.-group). Procedure-related mortality (3.6% <90y.-group vs. 3.3% ≥90y.-group, log-rank p =0.9) and device success (97.2% <90y.-group vs. 96.0% ≥90y.-group, p =0.44) were similar. Estimated survival rates at 2 years were 62.8% (95% CI 55.3 and 71.4) in the elder and 76.0% (95% CI 74.1 and 77.8) in the younger patients ( p <0.01). The incidence of acute kidney injury, stroke, major bleeding, and permanent pacemaker implantations were comparable between both groups. TAVR procedure is equally safe and feasible in patients aged 90 years or older compared to younger patients. Differences in 2-year survival appear to be patient-related rather than procedure-related.