Feasibility of transcatheter intervention for severe aortic stenosis in patients >or=90 years of age: aortic valvuloplasty revisited.
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.
Pedersen
Wes R
WR
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA. Wesley.Pedersen@allina.com
Klaassen
Paul J
PJ
Boisjolie
Charlene R
CR
Pierce
Talia A
TA
Harris
Kevin M
KM
Lesser
John R
JR
Hara
Hidehiko
H
Mooney
Michael R
MR
Graham
Kevin J
KJ
Kshettry
Vibhu R
VR
Goldenberg
Irvin F
IF
Priztker
Marc R
MR
Van Tassel
Robert A
RA
Schwartz
Robert S
RS
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