Risk assesment in TAVI including valve-in-valve
Comparison of effectiveness and safety of TAVI in patients ≥90 years of age versus <90 years of age
Aims: In a fraction of patients aged ≥90 years, less invasive transcatheter aortic valve implantation (TAVI) has been considered as a therapeutic option for aortic stenosis (AS) under careful clinical screening. However, the safety and effectiveness of using TAVI in such a population has not been fully elucidated. The aim of this study was to investigate the feasibility of TAVI in nonagenarians.
Methods and results: We prospectively enrolled 136 consecutive patients with severe AS who were referred for TAVI. Procedural, early- and mid-term clinical outcomes were compared between patients aged <90 (n=110; average age, 82.3±8.3) and ≥90 (n=26; average age, 91.6±1.9) years old. Comparison of baseline characteristics revealed that among patients ≥90 years, prevalence of females was higher (50% vs. 81%, p<0.001) and mean aortic valve gradient was greater (45.5±15.4 mmHg vs. 56.3±23.4 mmHg, p=0.005) than those in patients <90 years. Major vascular complications occurred more frequently in patients ≥90 years (5% vs. 19%, p=0.022), while the rate of procedural success, 30-day and six months, mortality were not different between the two age groups (96% vs. 100%, p=0.58; 6% vs. 15%, p=0.22; 14% vs. 27%, p=0.14, respectively). Mortality rates were higher among patients ≥90 years. At six-months, both groups of survivors were similar in symptom status, having New York Heart Association classifications below Class II (89% vs. 84%, p=0.68). The cumulative survival (median 13.4±8.0 months of follow-up) was not significantly different between the two age groups (p=0.22, log rank test).
Conclusions: Even very elderly nonagenarians might experience acceptable clinical results and benefits after TAVI.
