The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Outcomes in nonagenarians undergoing transcatheter aortic valve implantation (TAVI): data from a nationwide analysis.

DOI: 10.4244/EIJ-D-19-00647

1. Cardiologie, CHU-Timone, Marseille, France; Aix-Marseille University, C2VN, Marseille, France, France
2. Cardiologie, CHU Trousseau, EA7505, France.
3. Cardiologie, CHU Trousseau, EA7505, France;Unité d’épidémiologie hospitalière régionale, CHU et Faculté de Médecine, France
4. Cardiologie, CHU Trousseau, EA7505, France; Unité d’épidémiologie hospitalière régionale, CHU et Faculté de Médecine, France
5. Cardiologie, CHU Trousseau, EA7505, France.
6. Aix-Marseille University, C2VN, Marseille, France; Chirurgie Cardiaque, CHU-Timone Marseille, France.
7. Aix-Marseille University, C2VN, Marseille, France; Chirurgie Cardiaque, CHU-Timone Marseille, France.
8. Aix-Marseille University, C2VN, Marseille, France; Chirurgie Cardiaque, CHU-Timone Marseille, France.
9. Chirurgie Cardiaque, CHU-Tours, France.
10. Cardiologie, CHU-Timone, Marseille, France; Aix-Marseille University, C2VN, Marseille, France
11. Cardiologie, CHU Trousseau, EA7505, France; Unité d’épidémiologie hospitalière régionale, CHU et Faculté de Médecine, France
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Aims: To describe the mid-term outcomes in nonagenarians undergoing transcatheter aortic valve implantation (TAVI). 

Methods and results: Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis (AS), and specifically those treated with TAVI between 2010 and 2018. Cox regression was used for the analysis of predictors of events. We compared patients according to their age. Within the studied period, 71,095 patients older than 90 yo with AS were identified. After matching on baseline characteristics, TAVI was associated with lower rates of a combined outcome of all-cause death, rehospitalization for heart failure and stroke (Relative risk (RR) 0.58, p<0.001) in comparison with matched nonagenarians with AS treated medically. During follow-up (median 161, interquartile range 13-625), the combined outcome occurred more frequently in nonagenarians (RR 1.22, p<0.01) who had a TAVI than in younger patients undergoing this procedure. All cause death was reported in 17.6% vs. 14.5% of nonagenarians, rehospitalization for heart failure in 21.3% vs. 18.2% and stroke in 3.7% vs. 2.9% (p<0.01 for all parameters). We identified Charlson comorbidity index, heart failure, atrial fibrillation, stroke, vascular disease, cognitive impairment and denutrition as independent predictors of adverse outcomes in nonagenarians undergoing TAVI. 

Conclusions:Within nonagenarians with AS, patients treated with TAVI had lower risk of cardiovascular events than matched patients treated medically. The patients undergoing a TAVI at this age were often highly selected and the procedure was associated with acceptable long term outcomes.

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