title: Feasibility of transcatheter intervention for severe aortic stenosis in patients >or=90 years of age: aortic valvuloplasty revisited.
abstract: OBJECTIVE
  The goals of this study were to determine the feasibility, safety, and early outcomes of balloon aortic valvuloplasty (BAV) for severe aortic stenosis in a nonagenarian population.
  
  
  BACKGROUND
  This very elderly population is expanding rapidly, has a high incidence of aortic stenosis, and uncommonly undergoes surgical aortic valve replacement. These patients may best be treated with a transcatheter approach due to comorbidities, surgical risk, and personal preference.
  
  
  METHODS
  We reviewed 31 consecutive patients >or=90 years of age who underwent BAV at our institution from July 2003 to August 2006 for data pertinent to patient characteristics, procedural techniques, and 30-day outcomes.
  
  
  RESULTS
  Our patients had a mean age of 93 +/- 3.0 years (90-101). The society of thoracic surgery risk score was 18.5 (+/-10.2) and logistic Euroscore was 35.8 (+/-19.3). Twenty-five patients (81%) underwent retrograde BAV and 6 (19%) antegrade BAV. Five patients (16%) underwent combined BAV and coronary stenting. Overall mean aortic valve area increased from 0.52 cm2 (+/-0.17) to 0.92 cm2 (+/-0.22) and mean New York Heart Association (NYHA) functional class improved from 3.4 to 1.8. Intraprocedural mortality occurred in one patient (3.2%) and 30-day mortality in three patients (9.7%).
  
  
  CONCLUSIONS
  BAV can be carried out in high risk nonagenarian patients with an acceptable complication rate, low perioperative mortality, and early improvement in NYHA functional class.
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA. Wesley.Pedersen@allina.com
authors.forename: Wes R
authors.initials: WR
authors.lastname: Pedersen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Klaassen
authors.forename: Charlene R
authors.initials: CR
authors.lastname: Boisjolie
authors.forename: Talia A
authors.initials: TA
authors.lastname: Pierce
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harris
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mooney
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Graham
authors.forename: Vibhu R
authors.initials: VR
authors.lastname: Kshettry
authors.forename: Irvin F
authors.initials: IF
authors.lastname: Goldenberg
authors.forename: Marc R
authors.initials: MR
authors.lastname: Priztker
authors.forename: Robert A
authors.initials: RA
authors.lastname: Van Tassel
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schwartz
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D012107:Research Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome