title: Morbidity and mortality of nonagenarians undergoing CoreValve implantation.
abstract: BACKGROUND
  Nonagenarians are mostly denied from different therapeutic strategies due to high comorbidity index and risk-benefit calculation. We present the results of nonagenarians with high comorbidity index not eligible for conventional aortic valve surgery undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve system.
  
  
  METHODS
  Our retrospective analysis include baseline parameters, procedural characteristics, morbidity, mortality as well as twelve-lead surface ECG and echocardiographic parameters which were revealed preinterventionally, at hospital discharge and at 30-day follow-up. Clinical follow-up was performed 6 months after TAVI.
  
  
  RESULTS
  Out of 158 patients 11 nonagenarians with a mean age of 92.6 ± 1.3 years suffering from severe aortic valve stenosis and elevated comorbidity index (logistic EuroSCORE of 32.0 ± 9.5%, STS score 25.3 ± 9.7%) underwent TAVI between January 2008 and January 2011 using the third-generation percutaneous self-expanding CoreValve prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.6 ± 0.2 cm(2) with a mean and peak pressure gradient of 60.2 ± 13.1 mmHg and 91.0 ± 27.4 mmHg, respectively. The 30-day follow up all cause and cardiovascular mortality was 27.3% and 9.1%, respectively. One major stroke (9.1%), 2 pulmonary embolisms (18.2%), 1 periprocedural (9.1%) and 1 (9.1%) spontaneous myocardial infarction occured. Life-threatening or disabling bleeding occurred in 2 cases (18.2%), and minor bleeding in 7 cases (63.6%). Mean severity of heart failure according to NYHA functional class improved from 3.2 ± 0.8 to 1.36 ± 0.5 while mean AVA increased from 0.6 ± 0.2 cm(2) to 1.8 ± 0.2 cm(2). At 6-months follow-up 8 patients (72.7%) were alive without any additional myocardial infarction, pulmonary embolism, bleeding, or stroke as compared to 30-day follow-up.
  
  
  CONCLUSIONS
  Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with CoreValve.
authors.affiliation: Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str 6, 18057 Rostock, Germany. Ibrahim.akin@med.uni-rostock.de
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.forename: Lylia
authors.initials: L
authors.lastname: Paranskaya
authors.forename: Henrik
authors.initials: H
authors.lastname: Schneider
authors.forename: Tim C
authors.initials: TC
authors.lastname: Rehders
authors.forename: Gökmen R
authors.initials: GR
authors.lastname: Turan
authors.forename: Dimitar
authors.initials: D
authors.lastname: Divchev
authors.forename: Gunther
authors.initials: G
authors.lastname: Kundt
authors.forename: Ilkay
authors.initials: I
authors.lastname: Bozdag-Turan
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies