Comparison of Outcomes of Transfemoral Aortic Valve Implantation in Patients &lt;90 With Those &gt;90 Years of Age

Vendrik, Jeroen; Mourik, Martijn S. van; Kesteren, Floortje van; Henstra, Marieke; Piek, Jan J.; Henriques, José P.S.; Wykrzykowska, Joanna J.; Winter, Robbert J. de; Vis, Marije M.; Koch, Karel T.; Baan, Jan

doi:10.1016/j.amjcard.2018.02.056

Cited by 20 publications

(24 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results are similar to those from other researchers . Vendrik et al reported that nonagenarians had more postoperative strokes (<72 hours) compared with younger counterparts. Our results regarding a similar prevalence of post‐TAVI stroke between nonagenarians and non‐nonagenarians might reflect an equivalent hospital stay after TAVI.…”

Section: Discussionsupporting

confidence: 91%

“…Several researchers have reported worse short‐term mortality in nonagenarians who underwent TAVI compared with that in non‐nonagenarians, but acceptable long‐term outcomes have been reported, especially for patients who underwent TAVI using a transfemoral approach . Those results support our data showing that patients aged ≥90 years tended to have higher 30‐day mortality in comparison with those aged <90 years, but there was no significant difference in 3‐year outcome in our study.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Long‐term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: A multi‐center analysis

Yokoyama

Tobaru

Muto

et al. 2019

Clinical Cardiology

View full text Add to dashboard Cite

Background and Hypothesis Japan is an aging society, and the number of nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) is increasing, but their outcomes have not been determined fully. Methods We prospectively enrolled 767 consecutive patients who underwent TAVI in three Japanese institutions. Clinical characteristics and outcomes of nonagenarians (n = 94) were evaluated and compared with those of patients aged <90 years (n = 673). Results Prevalence of New York Heart Association (NYHA) class III/IV was not different between the two groups. Preoperative risk scores were significantly higher in nonagenarians compared with those in non‐nonagenarians, whereas the Clinical Frailty Scale was not different. Thirty‐day mortality tended to be higher ( P = .06) and major vascular complication was significantly higher in nonagenarians than in non‐nonagenarians ( P < .05), but 3‐year mortality was equivalent between the two groups. Even after adjustment for covariates, female sex (hazard ratio, 0.41; 95% confidence interval: 0.25‐0.67), body mass index (0.87, 0.80‐0.94), and NYHA class III/IV (1.84, 1.06‐3.29) were associated with all‐cause mortality. Age ≥ 90 years was not associated with all‐cause mortality. Conclusions TAVI could be undertaken safely and effectively in nonagenarians, who had acceptable long‐term results compared with those for younger patients, although careful attention should be paid to major vascular complication.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Long‐term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: A multi‐center analysis

Yokoyama

Tobaru

Muto

et al. 2019

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Interestingly, this 1‐year mortality is not drastically different than that of nonagenarians in the general population, which is approximately 15%. In studies comparing patients above and below age 90, the risk of mortality was slightly increased in some studies and no different in others . This inconsistency is at least partially attributable to variable adjustment for age‐related confounders.…”

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 98%

“…These structural changes become more severe in response to chronic pressure overload from AS, and they may introduce technical complexity when deploying a transcatheter valve. Nonagenarians undergoing TAVR are also more likely to present with multi‐valve disease; with 15%‐64% exhibiting concomitant moderate or severe mitral regurgitation —a finding associated with a 2‐fold increase in mortality following TAVR . Another common yet concerning finding in nonagenarians is pulmonary hypertension; with 21%‐44% exhibiting systolic pulmonary arterial pressures >60 mmHg …”

Section: The Nonagenarian Phenotypementioning

confidence: 99%

“…Nonagenarians undergoing TAVR are more likely to be women, which is not surprising considering that nonagenarian women outnumber nonagenarian men by 3‐to‐1 in the general population. Nonagenarians undergoing TAVR are less likely to present with comorbid coronary artery disease, peripheral arterial disease, diabetes mellitus, and multiple chronic conditions . These differences can be explained by the healthy survivor effect, the clinician's cognitive bias to be conservative in nonagenarians with significant comorbidities, or a combination of the two.…”

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 99%

See 1 more Smart Citation

Transcatheter aortic valve replacement over age 90: Risks vs benefits

Galatas

Afilalo

2019

Clinical Cardiology

View full text Add to dashboard Cite

As the population ages, clinicians will encounter a growing number of nonagenarians suffering from severe aortic stenosis who may be candidates for transcatheter aortic valve replacement (TAVR). By virtue of a healthy survivor effect or a referral bias, these patients may paradoxically have greater resilience and fewer comorbidities than their octogenarian counterparts. They tend to, on average, tolerate the TAVR procedure quite well with low in‐hospital and 1‐year mortality rates of 5.5% and 23%, respectively. Appropriate patient selection should consider individualized estimates of procedural risk, potential for functional recovery and for improved quantity and quality of life. Frailty is much more revealing than chronological age, and it can be measured by brief tools such as the Essential Frailty Toolset. Ultimately, the process of shared decision‐making is paramount to ensure that the course of action is patient‐centered and balances the procedure's expected risks and benefits with the nonagenarian's preferences and values.

show abstract

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

Comparison of Outcomes of Transfemoral Aortic Valve Implantation in Patients <90 With Those >90 Years of Age

Cited by 20 publications

References 21 publications

Long‐term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: A multi‐center analysis

Long‐term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: A multi‐center analysis

Transcatheter aortic valve replacement over age 90: Risks vs benefits

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

Contact Info

Product

Resources

About