Trans-catheter aortic valve implantation (TAVI) became available at Auckland City Hospital in 2011 for patients with severe aortic stenosis in whom surgical aortic valve replacement (AVR) was deemed at high risk. We assessed whether introduction of TAVI affected the characteristics and outcomes of octogenarians undergoing AVR.
Isolated AVR performed in patients ≥80 years of age during 2008–2012 were divided into two groups, pre- and post-TAVI introduction, for analyses.
Isolated AVR was undertaken in 35 and 33 octogenarians pre- and post-TAVI introduction. The post-TAVI group were older (84.2 vs 82.3 years, P = 0.003), had lower ejection fraction (P = 0.026), more had inpatient surgery (76% vs 29%, P < 0.001), with higher EuroSCORE II (5.4 vs 3.9%, P = 0.033). Operative mortality was 0.0% in both groups. One-year survival was similar (97.6% vs 94.3%, P = 0.613), but composite morbidity was lower in the post-TAVI group (9.1% vs 31.4%, P = 0.035). Chronic respiratory disease (P = 0.043) independently predicted mortality during follow-up, while number of coronary vessel > 50% stenosis (P = 0.050), creatinine clearance (P = 0.016) and being in the pre-TAVI era group (P = 0.022) predicted composite morbidity.
Since TAVI was introduced, mean age and risk scores significantly increased in octogenarians undergoing AVR, while mortality rates remained similar and composite morbidity decreased.
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- Help wanted? Providing and paying for long-term care.OECD Health Policy Studies, OECD Publishing, 2011
- Changing aspects of the natural history of valvular aortic stenosis.N Engl J Med. 1987; 317: 91-98
- Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation.Circulation. 2005; 111: 920-925
- A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease.Eur Heart J. 2003; 24: 1231-1243
- Burden of valvular heart diseases: a population-based study.Lancet. 2006; 368: 1005-1011
- Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a cohort of 277 patients aged> or =80 years.Eur J Cardiothorac Surg. 2006; 30: 722-727
- ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.Circulation. 2006; 114: e84-e231
- Guidelines on the management of valvular heart disease (version 2012).Eur Heart J. 2012; 33: 2451-2496
- Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.Circulation. 2002; 106: 3006-3008
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement.J Am Coll Cardiol. 2012; 59: 1200-1254
- The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery.Ann Thorac Surg. 2009; 88: S23-S42
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- European system for cardiac operative risk evaluation (EuroSCORE).Eur J Cardiothorac Surg. 1999; 16: 9-13
- The logistic EuroSCORE.Eur Heart J. 2003; 24: 881-882
- EuroSCORE II.Eur J Cardiothorac Surg. 2012; 41: 734-744
- What is the impact of providing a transcatheter aortic valve implantation service on conventional aortic valve surgical activity: patient risk factors and outcomes in the first 2 years.Heart. 2010; 96: 1633-1637
- Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up.J Am Coll Cardiol. 1991; 18: 29-35
- Outcome after aortic valve replacement in octogenarians.Ann Thorac Surg. 2004; 78: 85-89
- Cardiac operations in patients 80 years old and older.Ann Thorac Surg. 1997; 64: 606-614
- Cardiac surgery in octogenarians; peri-operative outcome and long-term results.Eur Heart J. 2001; 22: 1235-1243
- Aortic valve replacement in octogenarians: risk factors for early and late mortality.Ann Thorac Surg. 2007; 83: 1651-1656
- Aortic valve replacement in octogenarians: is biologic valve the unique solution?.Ann Thorac Surg. 2008; 85: 1296-1301
- Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?.Eur Heart J. 2005; 26: 2714-2720
- Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?.Eur J Cardiothorac Surg. 2009; 35: 953-957
Published online: November 19, 2013
Accepted: October 17, 2013
Received in revised form: August 22, 2013
Received: July 26, 2013
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.