Transcatheter aortic valve implantation in nonagenarians: Effective and safe

Noble, Stéphane; Frangos, Emilia; Samaras, Nikolaos; Ellenberger, Christophe; Frangos, Caroline; Çıkırıkçıoğlu, Mustafa; Bendjelid, Karim; Frei, Angela; Myers, Patrick Olivier; Licker, Marc; Roffi, Marco

doi:10.1016/j.ejim.2013.07.007

Cited by 36 publications

(30 citation statements)

References 27 publications

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“…There have been studies that assessed the safety and effectiveness of TAVI in nonagenarians in Europe and the USA. [17][18][19][20][21][22] In this study, 22.3% of patients were at least 90 years old. This is higher than the reported percentage of patients who underwent TAVI in the FRANCE-2 Registry (10.1%) 17) and the STS/ACC TVT Registry in the USA (15.7%).…”

Section: Discussionmentioning

confidence: 99%

Early Safety and Efficacy of Transcatheter Aortic Valve Implantation for Asian Nonagenarians (from KMH Registry)

et al. 2017

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SummaryAs Japan has one of the most rapidly aging populations in the world, transcatheter aortic valve implantation (TAVI) is likely to be performed in increasing numbers of older people. There is little information on either the efficacy or the safety of TAVI in nonagenarians in Asia.From October 2013 to June 2015, 112 consecutive patients underwent TAVI with Edwards SAPIEN XT valves in our institution. We compared 25 patients aged at least 90 years (mean 91.6 ± 1.7 years) with 87 patients aged under 90 years (mean 82.5 ± 6.0 years) at the time of TAVI. All definitions of clinical endpoints and adverse events were based on the Valve Academic Research Consortium 2 definitions.The median follow-up interval was 561.5 days (the first and third quarters, 405.0 and 735.8 days). Nonagenarians had a higher logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), Euro II score, and the Society of Thoracic Surgeons predictive risk of mortality (STS) score, and a prevalence of clinical frailty scale !4. The rate of device success, and the 30-day and 6-month mortalities were not different between patients aged !90 years and < 90 years (96.0% versus 92.0%, P = 0.68; both 0%, P = 1.00; 4.0% versus 3.5%, P = 0.32, respectively). At six months, clinical efficacy and time-related valve safety were also similar in the two groups (12.5% versus 13.4%, P = 1.00; 4.5% versus 10.3%, P = 0.68, respectively). The cumulative 1-year mortalities were not significantly different between the two groups (8.4% versus 9.4%, P = 0.94, respectively).TAVI can contribute to acceptable clinical results and benefits in a carefully selected group of nonagenarians in Asia.(Int Heart J 2017; 58: 900-907)

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Section: Discussionmentioning

confidence: 99%

Early Safety and Efficacy of Transcatheter Aortic Valve Implantation for Asian Nonagenarians (from KMH Registry)

et al. 2017

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“…In those series, reported operative mortality rates associated with valve replacement vary from 0% to 17% [3,11]. Noble and colleagues [2], however, recently reported their series of 23 nonagenarian patients (90.3 AE 2.3 years) who underwent TAVR. They reported a 30-day mortality rate of 8.7%.…”

Section: Commentmentioning

confidence: 96%

“…Such patients with severe aortic valve stenosis may therefore not be considered candidates for aortic valve replacement [1]. Unfortunately there are limited outcome data to guide members of the multidisciplinary heart team on aortic valve replacement in these patients [2,3]. The aim of this study is to report our experience with aortic valve replacement in patients 90 years or older.…”

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confidence: 96%

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

Murashita

Greason

Suri

et al. 2014

The Annals of Thoracic Surgery

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“…As deduced from studies reporting results of TAVI in nonagenarians summarized in Table 1, TAVI, as long as it is performed via the transfemoral route, is feasible and relatively safe and effective in this patient subpopulation, albeit at higher risk compared to younger patients, with satisfactory short-and mid-term outcomes, however, long-term data are meagre (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Procedural and 30-day mortality ranges from 0% to 27%, hovering around 10%, stroke risk ranges from 2% to 18% (average 3-4%), bleeding and vascular complications range from 9% to 34% (average ~16%), renal insufficiency ranges from 1% to 10%, while the emerging need for a pacemaker has a wide range depending on the type of valve employed (5-30%) (41).…”

Section: Clinical Outcomesmentioning

confidence: 99%

Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile?

Manolis¹,

Manolis²

2017

Ann. Cardiothorac. Surg.

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A growing number of nonagenarians is recorded as life expectancy increases. Unfortunately, this extreme-aged group is plagued by increased prevalence of aortic stenosis amidst a higher occurrence of comorbidities that pose dilemmas to cardiologists and cardiac surgeons when having to choose a conservative or interventional treatment modality, and a surgical or transcatheter aortic valve implantation (TAVI) approach. TAVI is an expensive procedure, which also confers a higher mortality and morbidity risk in nonagenarians, compared to younger patients. Considering the physiologic rather the chronologic age alone, and adopting a shared-decision making approach (participatory medicine), it may be more realistic to determine a patient's candidacy for this non-surgical therapeutic modality. Thus, it comes down to the patient selection process by having the heart team review each nonagenarian case individually and getting the patient and the family involved, always aiming to prolong and improve patient's quality of life (QoL), but also taking into consideration patient preferences and values, sharing and respecting goals, realistic expectations, and end-of-life views and ideas. One should keep in mind that there is always the possibility that TAVI may be clinically futile for patients who have a multitude of comorbidities and extreme frailty, for whom a transition to palliative care might be prudent. Selecting nonagenarian patients with low comorbidity index and with no extreme frailty, adopting a minimalistic approach and paying attention to vascular access hemostasis may provide the elements that may lead to a successful, desirable and hopefully cost-effective outcome.

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Transcatheter aortic valve implantation in nonagenarians: Effective and safe

Cited by 36 publications

References 27 publications

Early Safety and Efficacy of Transcatheter Aortic Valve Implantation for Asian Nonagenarians (from KMH Registry)

Early Safety and Efficacy of Transcatheter Aortic Valve Implantation for Asian Nonagenarians (from KMH Registry)

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

Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile?

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