TY - JOUR
T1 - Clinical profiles and correlates of mortality in nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve replacement
AU - Escárcega, Ricardo O.
AU - Baker, Nevin C.
AU - Lipinski, Michael J.
AU - Koifman, Edward
AU - Kiramijyan, Sarkis
AU - Magalhaes, Marco A.
AU - Gai, Jiaxiang
AU - Torguson, Rebecca
AU - Satler, Lowell F.
AU - Pichard, Augusto D.
AU - Waksman, Ron
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background Transcatheter aortic valve replacement (TAVR) is the current standard for nonoperable and high-risk surgical patients with aortic stenosis, including those of advanced age. However, the clinical profiles, procedural characteristics, and outcomes of nonagenarians undergoing TAVR have not been thoroughly reported. Methods A total of 654 patients (n = 107 >90 years old and n = 547 <90 years) with severe aortic stenosis undergoing TAVR were included in this analysis. Baseline characteristics, procedural variables, and in-hospital outcomes and complications at 30 days and 12 months were analyzed. Results Overall, of the patients included, 46% were high risk and 53% inoperable. Although nonagenarians had a higher Society of Thoracic Surgeons score of 9.2 ± 4 (12.1 ± 4 vs 8.6 ± 4, P <.001), other factors were considerably lower in this group: diabetes (22% vs 36%, P =.008), hyperlipidemia (65% vs 83%, P <.001), prior coronary artery bypass (13% vs 39%, P <.001), and mean body mass index (24.5 ± 5 vs 28.1 ± 7 kg/m2, P <.001). The correlates for 1-year mortality in nonagenarians were as follows: ≥moderate aortic insufficiency post-TAVR (hazard ratio [HR] 5.07, 95% CI 1.17-22, P =.03), pacemaker implantation after TAVR (HR 6.87, 95% CI 2.32-20.3, P =.001), and peripheral vascular disease (HR 2.35, 95% CI 1.03-5.38, P =.042). Mortality at 30 days (12.1% vs 7.1%, P =.07) and at 1 year (25% vs 21%, P =.35) was similar between groups. Conclusion Nonagenarians undergoing TAVR had a healthier clinical profile compared with younger patients. Age alone should not be a discriminatory factor when screening elderly patients with aortic stenosis because even the nonagenarians are doing well when compared with the younger elderly population. Transcatheter aortic valve replacement remains a viable option for the treatment of severe symptomatic aortic stenosis for the elderly regardless of their age.
AB - Background Transcatheter aortic valve replacement (TAVR) is the current standard for nonoperable and high-risk surgical patients with aortic stenosis, including those of advanced age. However, the clinical profiles, procedural characteristics, and outcomes of nonagenarians undergoing TAVR have not been thoroughly reported. Methods A total of 654 patients (n = 107 >90 years old and n = 547 <90 years) with severe aortic stenosis undergoing TAVR were included in this analysis. Baseline characteristics, procedural variables, and in-hospital outcomes and complications at 30 days and 12 months were analyzed. Results Overall, of the patients included, 46% were high risk and 53% inoperable. Although nonagenarians had a higher Society of Thoracic Surgeons score of 9.2 ± 4 (12.1 ± 4 vs 8.6 ± 4, P <.001), other factors were considerably lower in this group: diabetes (22% vs 36%, P =.008), hyperlipidemia (65% vs 83%, P <.001), prior coronary artery bypass (13% vs 39%, P <.001), and mean body mass index (24.5 ± 5 vs 28.1 ± 7 kg/m2, P <.001). The correlates for 1-year mortality in nonagenarians were as follows: ≥moderate aortic insufficiency post-TAVR (hazard ratio [HR] 5.07, 95% CI 1.17-22, P =.03), pacemaker implantation after TAVR (HR 6.87, 95% CI 2.32-20.3, P =.001), and peripheral vascular disease (HR 2.35, 95% CI 1.03-5.38, P =.042). Mortality at 30 days (12.1% vs 7.1%, P =.07) and at 1 year (25% vs 21%, P =.35) was similar between groups. Conclusion Nonagenarians undergoing TAVR had a healthier clinical profile compared with younger patients. Age alone should not be a discriminatory factor when screening elderly patients with aortic stenosis because even the nonagenarians are doing well when compared with the younger elderly population. Transcatheter aortic valve replacement remains a viable option for the treatment of severe symptomatic aortic stenosis for the elderly regardless of their age.
UR - http://www.scopus.com/inward/record.url?scp=84960346522&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2015.12.012
DO - 10.1016/j.ahj.2015.12.012
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C2 - 26920604
AN - SCOPUS:84960346522
SN - 0002-8703
VL - 173
SP - 118
EP - 125
JO - American Heart Journal
JF - American Heart Journal
ER -
