Transcatheter Aortic Valve Implantation in Nonagenarians

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> In this report, we assess the outcome of transcatheter aortic valve implantation (TAVI) in nonagenarians at our institution during a 6-year period. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Between April 2008 and July 2014, 40 patients with a mean ± SD age of 91.8 ± 2.3 years (range, 90–98 years) underwent TAVI. Thirty-three patients (82.5%) received transapical TAVI, and seven patients (17.5%) received transfemoral TAVI. Baseline characteristics were as follows: mean ± SD EuroSCORE II, 23.9 ± 14.21; mean ± SD Society of Thoracic Surgeons mortality score, 24.2 ± 11.4; mean ± SD SYNTAX score, 7.6 ± 9.3; mean ± SD NYHA class, 3.5 ± 0.5; mean ± SD transvalvular gradient, 46.8 ± 17.8 mm Hg; mean ± SD aortic valve area, 0.7 ± 0.2 cm<jats:sup>2</jats:sup>. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Intraoperative mortality was 2.5% and 30-day all-cause mortality was 10%. The actuarial survival rates at 1 and 5 years were 58.6% and 30.4%, respectively. Seven patients (17.5%) underwent simultaneous elective TAVI and percutaneous coronary intervention. Three patients (7.5%) were operated on with the use of cardiopulmonary bypass. No conversion to open surgery occurred. In transesophageal echocardiography assessment, no moderate or severe prosthetic aortic valve regurgitation was observed. Four patients (10%) had postoperative acute renal failure stage 3 and needed new dialysis (P = 0.125). Three patients (7.5%) had a disabling stroke. Periprocedural myocardial infarction occurred in one patient (2.5%). Seven patients (17.5%) needed postoperative pacemaker implantation. Male sex and renal insufficiency were found to be predictors of mortality in univariable analysis. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Transcatheter aortic valve implantation can be performed in nonagenarians despite very high preoperative risk scores and substantial multimorbidity, with acceptable outcomes. </jats:p></jats:sec>

Never Too Late: A Case Report on Transcatheter Aortic Valve Implantation in a 97-Year-Old Patient

“…The most common procedural complications in nonagenarians were vascular in nature and were significantly more likely to require surgical intervention than in the participants younger than 90 years [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. Gurvitch et al reported that post-procedural bleeding was most frequently due to Coumadin therapy for atrial fibrillation [20].…”

“…Buchanan et al discussed the occurrence of myocardial infarction in the perioperative phase due to dissection of the left main coronary artery after it was balloon dilated [23]. Other common in-hospital complications of TAVI included high-grade atrioventricular block requiring pacemaker implantation, atrial fibrillation, and stroke, respectively [12,13,14,15,16,17,18,23,24,25,26,27,28]. Nonagenarians were more likely to require transfer to the intensive care unit and to be discharged to an extended care facility as compared to their younger counterparts [15].…”

“…There were great variations in the death rates post TAVI, which were likely impacted by the sample sizes of the research articles. The 30-day all-cause mortality rates ranged from 0% to 27% [15,17,18,19,21,23,24,25,26,27], while the one-year mortality rates were between 10–32% [15,17,18,19,21,23]. However, survival at 5-year follow-up was 30.4% [25].…”

“…The 30-day all-cause mortality rates ranged from 0% to 27% [15,17,18,19,21,23,24,25,26,27], while the one-year mortality rates were between 10–32% [15,17,18,19,21,23]. However, survival at 5-year follow-up was 30.4% [25]. Most comparison studies revealed that mortality rates at one year were similar in nonagenarians versus the younger cohorts in [19,20,21,24].…”

“…The transfemoral versus the transapical approach was a predictor of lower 30-day mortality [21]. Furthermore, male gender and renal failure were found to be mortality predictors [25].…”