Background
The number of nonagenarian patients with aortic stenosis will likely increase due
to the ageing population. We assessed the clinical characteristics, management, and
outcomes of nonagenarian patients with severe aortic stenosis.
Methods
A total of 177 (117 females and 60 males) consecutive nonagenarian patients from two
large contemporary registries were included in this study. Clinical characteristics,
comorbidity as assessed by the Charlson Index, clinical management, and outcomes were
recorded. The main outcome measure was 1-year mortality.
Results
The mean patient age was 91.1 years, and 56 patients (31.6%) had a Charlson Index
<3. A strong association between comorbidity and 1-year overall mortality was observed,
with higher 1-year mortality in patients with Charlson Index ≥3 (66.4% vs. 32.1%,
p < 0.001). A total of 150 patients (84.7%) were managed conservatively, and 27 (15.3%)
underwent transcatheter aortic valve implantation (TAVI). Predictors of a conservative
management were treatment out of TAVI centres, lower mean aortic gradient and better
functional class. Clinical management was not significantly different with different
degrees of comorbidity. A trend toward higher mortality in patients undergoing conservative
management was observed (58% vs. 40.7%, p = 0.097). Independent predictors of mortality were higher Charlson Index, lower creatinine
clearance, lower mean aortic gradient, poorer left ventricular ejection fraction,
significant mitral regurgitation and conservative management.
Conclusions
About one third of nonagenarians with severe aortic stenosis have few comorbidities.
The clinical management was similar irrespective of the Charlson Index. Both higher
Charlson Index values and a conservative management were independently associated
with a higher mortality.
Keywords
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Article info
Publication history
Published online: April 11, 2017
Accepted:
February 28,
2017
Received in revised form:
January 25,
2017
Received:
October 20,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
