TAVR in nonagenarians: An analysis investigating safety, efficacy, symptomatic improvement, and long-term survival

Zadrozny, Magda; Hainzer, Nathalie; Mehilli, Julinda; Jochheim, David; Gschwendtner, Sarah; Steffen, Julius; Theiß, Hans; Braun, Daniel; Hagl, Christian; Sadoni, Sebastian; Maßberg, Steffen; Hausleiter, Jöerg; Deseive, Simon

doi:10.1016/j.jjcc.2021.01.016

Cited by 7 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cohort, minor and major bleeding complications (VARC-3 Type 1 and Type 2) occurred in 31.4% and 15.7%, respectively, but did not differ between the groups. This is in line with other studies analyzing TAVR in nonagenarian patients without cerebral protection systems [ 7 ]. However, our complication rates are higher compared to previous studies analyzing the performance of the Triguard 3 system in younger patients, which reported lower bleeding and access site complication [ 22 ].…”

Section: Discussionsupporting

confidence: 92%

“…Due to the improvement in transfemoral aortic valve systems and increased knowledge of implanting physicians, the stroke rate in nonagenarian patient cohorts decreased to 4–7% in recent years [ 6 ]. In this very frail patient collective, there is a significant interest in strategies to reduce the risk of stroke after TAVI [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…A substantial proportion of patients submitted to TAVR continues to be affected by procedure-related neurological events, with 30-day clinical stroke rates in the range of 4–7% [ 5 , 6 , 7 ]. Especially in elder patients, cerebrovascular events (CVEs), such as postinterventional delirium, transient ischemic attack (TIA) or stroke, are devastating adverse events and have been identified as independent predictors of increased mortality and morbidity during follow-up [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Lind

Jánosi

Totzeck

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Transcatheter aortic valve replacement (TAVR) improves the survival and life quality of nonagenarian patients with aortic stenosis. Stroke remains one of the most worrisome complications following TAVR. Cerebral embolic protection devices (CEPDs) may reduce neurological complications after TAVR. This study evaluated the safety and efficacy of CEPDs during TAVR in nonagenarian patients. Methods: Between January 2018 and October 2021, 869 patients underwent transfemoral TAVR (TF-TAVR) at our center. Of these, 51 (5.9%) patients were older than ninety years. In 33 consecutive nonagenarian patients, TF-TAVR was implanted without CEPDs using balloon-expandable valves (BEVs) and self-expandable valves (SEVs). Eighteen consecutive nonagenarians underwent TF-TAVR using a CEPD (CP group). Follow up period was in-hospital or 30 days after the procedure, respectively. Results: Minor access site complications occurred in two patients (3.9%) and were not CEPD-associated. Postinterventional delirium occurred in nine patients (17.6%). Periprocedural minor non-disabling stroke and delirium occurred in ten patients (19.6%). Periprocedural major fatal stroke occurred in two patients in the BEV group (3.9%). Two patients in the BEV group died due to postinterventional pneumonia with sepsis. The mortality rate was 7.8%. The results did not differ between the groups. Conclusions: Age alone is no longer a contraindication for TAVR. CEPD using the Triguard 3 system in nonagenarian TAVR patients was feasible and safe and did not increase access site complications.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Lind

Jánosi

Totzeck

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…However, the incidence of conduction disturbances including bradycardia, left bundle branch block (LBBB), right bundle branch block (RBBB), and high grade atrio-ventricular block (HAVB) remains high. Permanent pacemaker implantation (PPI) following TAVR with self-expandable valves is frequent and occurs in 17–40% of patients [ 6 , 7 , 8 ]. In particular, patients treated with self-expandable valves and baseline conduction disturbances show a higher incidence of PPI after TAVR [ 7 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Doldi

Stolz

Escher

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.

show abstract

“…previously showed similar 2-year survival in the general population vs nonagenarians, but they used an average mortality and not a direct age-, sex-, and year of referral-matched comparison. 32 This difference is a potential explanation for the current results, as improvements in TAVR technology during the years may have contributed to creating this survival benefit. Another possible explanation for these results may be related to the fact that the nonagenarians undergoing TAVR are highly selected and are those with few life expectancy–limiting comorbidities in addition to the AS.…”

Section: Discussionmentioning

confidence: 94%

Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

Bernard,

St-Louis,

Robichaud

et al. 2023

CJC Open

View full text Add to dashboard Cite

TAVR in nonagenarians: An analysis investigating safety, efficacy, symptomatic improvement, and long-term survival

Cited by 7 publications

References 26 publications

Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

Contact Info

Product

Resources

About