Interventions for valvular disease and heart failure

Outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a nationwide analysis

EuroIntervention 2020;15:1489-1496. DOI: 10.4244/EIJ-D-19-00647

Pierre Deharo
Pierre Deharo1,2, MD, PhD; Arnaud Bisson2, MD; Julien Herbert2,3, MD; Thibaud Lacour2,3, MD; Christophe Saint Etienne2, MD; Alexis Theron4,5, MD; Alizée Porto4,5, MD; Frederic Collart4,5, MD; Thierry Bourguignon6, MD; Thomas Cuisset1,4, MD; Laurent Fauchier2,3, MD
1. Cardiologie, CHU-Timone, Marseille, France; 2. Cardiologie, CHU Trousseau, EA7505, Tours, France; 3. Unité d’Epidémiologie Hospitalière Régionale, CHU et Faculté de Médecine, Tours, France; 4. Aix-Marseille University, C2VN, Marseille, France; 5. Chirurgie Cardiaque, CHU-Timone, Marseille, France; 6. Chirurgie Cardiaque, CHU-Tours, Tours, France

Aims: The aim of this study was to describe the midterm 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 years with AS were identified. After matching on baseline characteristics, TAVI was associated with lower rates of a combined outcome of all-cause death, rehospitalisation 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 days, 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% versus 14.5% of nonagenarians, rehospitalisation for heart failure in 21.3% versus 18.2%, and stroke in 3.7% versus 2.9% (p<0.01 for all parameters). We identified the 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: Among nonagenarians with AS, patients treated with TAVI had a lower risk of cardiovascular events than matched patients treated medically. The patients undergoing a TAVI at this age were often highly selected; the procedure was associated with acceptable long-term outcomes.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

tavideathelderly (>75 years)
Interventions for valvular diseaseTAVI
Read next article
Systematic review and meta-analysis of current risk models in predicting short-term mortality after transcatheter aortic valve replacement

Latest news