Age-Related Outcomes After Transcatheter Aortic Valve Replacement

Attinger‐Toller, Adrian; Ferrari, Enrico; Tueller, David; Templin, Christian; Müller, Olivier; Nietlispach, Fabiàn; Toggweiler, Stefan; Noble, Stéphane; Roffi, Marco; Jeger, Raban; Huber, Christoph; Carrel, Thierry; Pilgrim, Thomas; Wenaweser, Peter; Togni, Mario; Cook, Stéphane; Heg, Dik; Windecker, Stephan; Goy, Jean‐Jácques; Stortecky, Stefan

doi:10.1016/j.jcin.2021.01.042

Cited by 35 publications

(19 citation statements)

References 16 publications

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“…In our analysis, we were able to identify various factors that drove the reduction in our primary outcome in the TAVR group, including age < 80 years, male gender, CKD stage 3 or more, large hospital size, and teaching hospital status. Previous studies corroborate our findings that younger age and higher hospital TAVR volume (likely correlated with larger hospital size) are associated with lower heart failure readmissions and mortality [16] , [17] . Interestingly, a previous meta -analysis of the short-term TAVR outcomes comparing teaching and non-teaching hospitals noted higher rates of acute kidney injury, hospital length of stay, and TAVR-related cost in teaching hospitals, however long-term mortality and heart failure readmissions rates were not assessed [18] .…”

Section: Discussionsupporting

confidence: 91%

Transcatheter aortic valve replacement in patients with aortic stenosis and cardiac amyloidosis

Khawaja

Jaswaney

Arora

et al. 2022

IJC Heart & Vasculature

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Section: Discussionsupporting

confidence: 91%

Transcatheter aortic valve replacement in patients with aortic stenosis and cardiac amyloidosis

Khawaja

Jaswaney

Arora

et al. 2022

IJC Heart & Vasculature

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“…Importantly, the mortality in this age group was still lower compared to CKD, heart failure, peripheral artery disease, and COPD. The results indicate a limited ability to discriminate patients based on chronological age alone most likely explained by selection and healthy survivor bias consistent with other findings [33] , [34] , [35] , [36] .…”

Section: Discussionsupporting

confidence: 90%

Mortality at one year after transcatheter aortic valve replacement – Relation of age and comorbidities

Strange¹,

Fosbøl²,

Sindet-Pedersen³

et al. 2022

IJC Heart & Vasculature

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“…In the SwissTAVI trial, elderly patients were more frequently discharged to nursing homes, but it was unclear whether these patients lived independently before admission. 20 In our study, we only included patients who lived independently before hospital admission and adjusted for patient frailty. Our study supports other reports that indicate that TAVR is associated with improved functional outcomes and quality of life measures, such as improvement in Short Form 12 physical component and mental component score, 21 6-minute walk test, 22 and basic activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study

Blank

Robitaille

Wachtendorf

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: The recommendation for transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in patients 65 to 80 years of age is equivocal, leaving patients with a difficult decision. We evaluated whether TAVR compared to SAVR is associated with reduced odds for loss of independent living in patients ≤65, 66 to 79, and ≥80 years of age. Further, we explored mechanisms of the association of TAVR and adverse discharge. METHODS: Adult patients undergoing TAVR or SAVR within a large academic medical system who lived independently before the procedure were included. A multivariable logistic regression model, adjusting for a priori defined confounders including patient demographics, preoperative comorbidities, and a risk score for adverse discharge after cardiac surgery, was used to assess the primary association. We tested the interaction of patient age with the association between aortic valve replacement (AVR) procedure and loss of independent living. We further assessed whether the primary association was mediated (ie, percentage of the association that can be attributed to the mediator) by the procedural duration as prespecified mediator. RESULTS: A total of 1751 patients (age median [quartiles; min–max], 76 [67, 84; 23–100]; sex, 56% female) were included. A total of 27% (222/812) of these patients undergoing SAVR and 20% (188/939) undergoing TAVR lost the ability to live independently. In our cohort, TAVR was associated with reduced odds for loss of independent living compared to SAVR (adjusted odds ratio [ORadj] 0.19 [95% confidence interval {CI}, 0.14–0.26]; P < .001). This association was attenuated in patients ≤65 years of age (ORadj 0.63 [0.26–1.56]; P = .32) and between 66 and 79 years of age (ORadj 0.23 [0.15–0.35]; P < .001), and magnified in patients ≥80 years of age (ORadj 0.16 [0.10–0.25]; P < .001; P-for-interaction = .004). Among those >65 years of age, a shorter procedural duration mediated 50% (95% CI, 28–76; P < .001) of the beneficial association of TAVR and independent living. CONCLUSIONS: Patients >65 years of age undergoing TAVR compared to SAVR had reduced odds for loss of independent living. This association was partly mediated by shorter procedural duration. No association between AVR approach and the primary end point was found in patients ≤65 years of age.

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Age-Related Outcomes After Transcatheter Aortic Valve Replacement

Cited by 35 publications

References 16 publications

Transcatheter aortic valve replacement in patients with aortic stenosis and cardiac amyloidosis

Transcatheter aortic valve replacement in patients with aortic stenosis and cardiac amyloidosis

Mortality at one year after transcatheter aortic valve replacement – Relation of age and comorbidities

Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study

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