Aortic Valve Replacement for Severe Aortic Valve Stenosis in the Nonagenarian Patient

Murashita, Takashi; Greason, Kevin L.; Suri, Rakesh M.; Nkomo, Vuyisile T.; Holmes, David R.; Rihal, Charanjit S.

doi:10.1016/j.athoracsur.2014.06.015

Cited by 32 publications

(19 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Only few small studies have attempted to compare TAVR versus SAVR in nonagenarians; however, these studies were single/two center experiences with small cohorts (59 nonagenarians in one study, and 110 in the other) . Consistent with the findings from our larger study, both studies showed a comparable incidence of in‐hospital mortality in both groups.…”

Section: Discussionsupporting

confidence: 81%

“…A recent analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry showed that the 30‐day and 1‐year mortality after TAVR in nonagenarians are only modestly elevated compared to younger patients . However, only few small studies have assessed the comparative efficacy and safety of TAVR versus SAVR among nonagenarians . With the projected growth of the very elderly population in the US, it is important to better understand the comparative outcomes of TAVR versus SAVR in this population.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Elgendy

Mahmoud

Elbadawi

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives To compare the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in nonagenarians. Background Data comparing the outcomes of TAVR versus SAVR in nonagenarians are limited. Methods Using the National Inpatient Sample years 2012–2014, hospitalization data were retrieved for subjects aged ≥90 years who underwent TAVR or SAVR for severe aortic stenosis. The incidence of in‐hospital mortality and peri‐procedural outcomes were compared using unadjusted, multivariate logistic regression, and propensity score matched analyses. Results The final cohort included 6,680 records of nonagenarians undergoing aortic valve replacement, among which 5,840 (87.4%) underwent TAVR. There was no difference in the incidence of in‐hospital mortality between both groups in the unadjusted (5.8% versus 6.0% P = 0.95), multivariate (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35–1.74), and propensity score matched (OR 1.07, 95% CI 0.75–1.51) analyses. In the propensity‐matched analysis, TAVR was associated with a lower incidence of acute kidney injury (OR 0.58, 95% CI 0.47–0.72), post‐operative blood transfusion (OR 0.51, 95% CI 0.43–0.61), a higher likelihood of discharge to home (OR 4.71, 95% 3.44–5.06), and a similar incidence of pacemaker placement (OR 1.16, 95% 0.89–1.53) and stroke (OR 1.34, 0.90–1.99). Conclusions In this nationwide analysis, TAVR was associated with an overall similar incidence of in‐hospital mortality and less morbidity compared with SAVR. These findings suggest that TAVR is effective and safe in nonagenarians.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Elgendy

Mahmoud

Elbadawi

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…The need for blood transfusion could have a multidimensional relation with kidney function; on one hand, it might signify increased blood loss and thus a higher probability for a hypotensive state, which is a main pathogenic mechanism of AKI. On the other hand new evidence suggests that storage causes structural changes to PRBCs leading to their release of proinflammatory molecules and procoagulant lipids, all of which can contribute to a direct injury to the kidneys . Moreover, we report a more complicated postoperative course for AKI+ patients with higher infection rates and significantly longer ICULOS and THLOS.…”

Section: Discussionmentioning

confidence: 64%

Acute Kidney Injury Following Surgical Aortic Valve Replacement

et al. 2015

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) is a significant complication of surgical aortic valve replacement (SAVR). This study sought to describe AKI following SAVR, its risk factors, predictors and effect on long-term survival. Methods We retrospectively reviewed 2169 patients who underwent isolated SAVR between 2000 and 2012. The main end-points were occurrence of AKI, postoperative complications, and short-and long-term survival rates following SAVR. Patients were divided into two groups: AKIR (n = 181) and AKIS (n = 1945). Results AKI occurred in 8.5% of patients, of which 3.9% (n = 7) needed dialysis. Predictors of AKI after SAVR were body mass index (BMI) and intraoperative packed red blood cells (PRBC) transfusion. AKIR patients had a more complicated postoperative course and higher cumulative mortality (25% vs. 17%, p = 0.012) with a median follow-up of 4.1 years. AKI was not found to be an independent predictor of mortality. Conclusions Predictors of AKI after SAVR are increased BMI and intraoperative PRBC transfusion. AKI conferred an increase in hospital length of stay and cumulative mortality while the need for postoperative dialysis was associated with the most complicated hospital stays and the highest in-hospital and cumulative mortalities; therefore careful recognition of patients at risk of AKI is warranted for a better preoperative renal optimization. However, incidence of AKI was lower than what is reported after both on-CPB cardiac surgeries and transcatheter aortic valve replacement, moreover AKI was not found to be an independent predictor of mortality.

show abstract

“…(6–9,18) In the largest previous study on TAVR in nonagenarians (346 nonagenarians out of 2,254 enrolled patients; reported from the French National Transcatheter Aortic Valve Implantation Registry (FRANCE-2)), Yamamoto and colleagues demonstrated a 30-day mortality of 11.2% in nonagenarians without any significant difference compared with patients age 80 to 84 or 85 to 89. (19) We found a lower 30-day mortality rate in nonagenarians (8.8%), which may reflect differences in patient selection and improvements in devices and techniques.…”

Section: Discussionmentioning

confidence: 99%

Should Transcatheter Aortic Valve Replacement Be Performed in Nonagenarians?

Arsalan

Szerlip

Vemulapalli

et al. 2016

Journal of the American College of Cardiology

View full text Add to dashboard Cite

Background Despite clinical trial evidence and clinical experience supporting the efficacy of transcatheter aortic valve replacement (TAVR), data demonstrating the benefit of TAVR specifically in the very elderly patients are limited, as they often represent only a small proportion of the clinical trial populations. Objectives To compare the outcomes of nonagenarians to younger patients undergoing TAVR in current clinical practice. Methods National U.S. data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry were analyzed. Outcomes at 30-days and 1-year were compared between patients ≥90 vs <90 years of age using cumulative incidence curves. Quality of life was assessed with the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Results Between November 2011 and September 2014, 24,025 patients underwent TAVR in 329 participating hospitals, of which 3,773 (15.7%) were age ≥90. The 30-day and 1-year mortality was significantly higher among nonagenarians (≥90 vs. <90: 30-day: 8.8% vs. 5.9%, p<0.001; 1-year: 24.8% vs. 22.0%, p<0.001, absolute risk 2.8%, relative risk 12.7%). However, nonagenarians had a higher mean STS PROM score(10.9% vs. 8.1%; p<0.001) and therefore had similar ratios of observed to expected rates of 30-day death (≥90 vs. <90: 0.81, 95% CI 0.70–0.92 vs. 0.72, 95% CI 0.67–0.78). There were no differences in the rates of stroke, aortic valve reintervention or myocardial infarction at 30-days or 1-year. Nonagenarians had lower (worse) median KCCQ-12 scores at 30-days; however, there was no significant difference at 1-year. Conclusions In current U.S. clinical practice, approximately 16% of patients undergoing TAVR are ≥90 years of age. Although 30-day and 1-year mortality was statistically higher compared with younger patients undergoing TAVR, the absolute and relative differences were clinically modest. TAVR also improves quality of life to the same degree in nonagenarians as in younger patients. These data support safety and efficacy of TAVR in select very elderly patients.

show abstract

Aortic Valve Replacement for Severe Aortic Valve Stenosis in the Nonagenarian Patient

Cited by 32 publications

References 17 publications

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Acute Kidney Injury Following Surgical Aortic Valve Replacement

Should Transcatheter Aortic Valve Replacement Be Performed in Nonagenarians?

Contact Info

Product

Resources

About