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 1 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.
Keywords
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References
Statistik der natürlichen Bevölkerungsbewegung. Statistisches Bundesamt (Destatis).
Global Health and Aging. NIH Publication No 11-7737. October 2011. World Health Organisation.
- The EuroHeart Failure survey programme – a survey on the quality of care among patients with heart failure in Europe.Eur Heart J. 2003; 24: 442-463
- Aortic Stenosis.Circulation. 1968; 38: V-61-V-67
- The natural history of aortic valve stenosis.Eur Heart J. 1988; 9: 57-64
- 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomized controlled trial.Lancet. 2015; 385: 2485-2491
The Society of Thoracic Surgeons. Adult cardiac surgery database, executive summary, 10 years STS report. https://www.sts.org/sites/default/files/documents/ACSD_ExecutiveSummary2017Harvest4.pdf.
- Cardiac Surgery in Germany during 2014: A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery.Thorac Cardiovasc Surg. 2015; 63: 258-269
- Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?.Eur Heart J. 2005; 26: 2714-2720
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.Eur Heart J. 2012; 33: 2403-2418
- Cardiac Surgery in Nonagenarians: Single-Centre Series and Review.Gerontology. 2010; 56: 378-384
- Survival and quality of life for nonagenarians after cardiac surgery.Ann Thorac Surg. 2013; 95: 1598-1602
- Cardiac surgery in nonagenarians: pushing the boundary one further decade.Arch Gerontol Geriatr. 2011; 53: 229-232
- Cardiac surgery in nonagenarians: not only feasible, but also reasonable?.Interact CardioVasc Thorac Surg. 2013; 17: 340-344
- Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ≥90 Years Versus <90 Years.Am J Cardiol. 2015; 116: 1110-1115
- Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve Replacement in the PARTNER-I Trial.Ann Thorac Surg. 2015; 100: 785-792
- Should Transcatheter Aortic Valve Replacement Be Performed in Nonagenarians? Insights from the STS/ACC TVT Registry.J Am Coll Cardiol. 2016; 67: 1387-1395
Article info
Publication history
Published online: June 15, 2017
Accepted:
May 24,
2017
Received in revised form:
May 8,
2017
Received:
March 1,
2017
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.
