Outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a nationwide analysis

Abstract

Aims:The aim of this study was to describe the midterm outcomes in nonagenarians undergoing transcatheter aortic valve implantation (TAVI).Methods and results: Based on the French administrative hospital discharge database, the study collected information for all consecutive patients with aortic stenosis (AS), and specifically those treated with TAVI between 2010 and 2018. Cox regression was used for the analysis of predictors of events. We compared patients according to their age. Within the studied period, 71,095 patients older than 90 years with AS were identified. After matching on baseline characteristics, TAVI was associated with lower rates of a combined outcome of all-cause death, rehospitalisation for heart failure and stroke (relative risk [RR] 0.58, p<0.001) in comparison with matched nonagenarians with AS treated medically. During follow-up (median 161 days, interquartile range 13-625), the combined outcome occurred more frequently in nonagenarians (RR 1.22, p<0.01) who had a TAVI than in younger patients undergoing this procedure. All-cause death was reported in 17.6% versus 14.5% of nonagenarians, rehospitalisation for heart failure in 21.3% versus 18.2%, and stroke in 3.7% versus 2.9% (p<0.01 for all parameters). We identified the Charlson comorbidity index, heart failure, atrial fibrillation, stroke, vascular disease, cognitive impairment and denutrition as independent predictors of adverse outcomes in nonagenarians undergoing TAVI.Conclusions: Among nonagenarians with AS, patients treated with TAVI had a lower risk of cardiovascular events than matched patients treated medically. The patients undergoing a TAVI at this age were often highly selected; the procedure was associated with acceptable long-term outcomes.

Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes

“…People living with severe aortic stenosis experience significant and rapid exacerbation of symptoms, increased mortality, morbidity, and hospital readmissions. 1 Due to the natural history of aortic stenosis, most patients are elderly, and are burdened with frailty and other multiple comorbidities. 2,3 Transcatheter aortic valve implantation (TAVI) is an established minimally invasive treatment option that enables patients to rapidly derive significantly improved quantity and quality of life, regardless of surgical risk profile.…”

Outcome of Nonagenarians Undergoing Transfemoral Transcatheter Aortic Valve Replacement

“…The 30-day mortality in our study was lower than that in previous reports. 5 , 6 , 7 The possible reasons may be: 1) the study period (ie, our study was performed during the mature phase of TAVR; TAVR was introduced into clinical practice in Japan in the second decade after the first-in-human TAVR [ie, 2002] under a specific program 10 ); 2) the high proportion of second-generation devices used (vs first-generation devices); and 3) the exclusion of patients with non-transfemoral access. In addition, Japanese practitioners might be cautious about TAVR interventions to nonagenarians.…”

“…With the aging of the population, the number of TAVRs performed in nonagenarians has also increased. Historically, nonagenarians have represented of 7% to 16% of patients in previous large-scale TAVR studies, 5 , 6 , 7 , 8 and this population is likely to continue to account for a substantial number of patients undergoing TAVR. However, randomized clinical trials on the effectiveness of TAVR did not enroll an adequate number of nonagenarian patients, and they are reported to be associated with a higher incidence of postprocedural complications and poor prognosis after TAVR from real-world databases.…”

“…However, randomized clinical trials on the effectiveness of TAVR did not enroll an adequate number of nonagenarian patients, and they are reported to be associated with a higher incidence of postprocedural complications and poor prognosis after TAVR from real-world databases. 5 , 6 , 7 , 8 For these reasons, the appropriateness of TAVR use in nonagenarians remains controversial, 9 and their outcome in contemporary TAVR (ie, transfemoral access, second generation valve, moderate anesthesia, high implantation method, and early discharge) is largely unknown.…”

Long-Term Outcomes After Transfemoral-Transcatheter Aortic Valve Implantation in Very Old Patients Using the Balloon-Expandable Bioprosthesis

“…Various data show a trend towards higher mortality in very old patients after TF-TAVI (Arsalan et al, 2016; Deharo et al, 2020; Pepe et al 2020). In our study, patients aged ≥85 years had similar long-term survival rates compared to patients aged <85 years.…”