title: Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis.
abstract: OBJECTIVE
  TAVI is the alternative option in pts with AS deemed ineligible for surgery. Although mortality and morbidity are measures to assess the effectiveness of treatments, quality of life (QOL) should be an additional target. We assessed clinical outcome and QOL in octogenarians following TAVI.
  
  
  METHODS
  All octogenarians with a risk profile considered by the Heart Team to be unacceptable for surgery entered in this registry. QOL was assessed by questionnaires concerning physical and psychic performance.
  
  
  METHODS
  A hundred forty-five octogenarians (age: 84.7 ± 3.4 years; male: 48.3%) underwent TAVI for AS (97.2%) or isolated AR (2.8%). NYHA class: 2.8 ± 0.6; Logistic EuroScore: 26.1 ± 16.7; STS score: 9.2 ± 7.7.Echocardiographic assessments included AVA (0.77 ± 0.21 cm2), mean/peak gradients (54.5 ± 12.2/88 ± 19.5 mm Hg), LVEF (21%=EF ≤ 40%), sPAP (43.1 ± 11.6 mmHg).
  
  
  METHODS
  All pts underwent successful TAVI using Edward-SAPIEN valve (71.2%) or Medtronic CoreValve (28.8%).
  
  
  METHODS
  Rates of mortality at 30 days, 6 months and 1 year were 2.8%, 11.2% and 17.5%.
  
  
  RESULTS
  At 16-month follow up, 85.5% survived showing improved NYHA class (2.8 ± 0.6 vs 1.5 ± 0.7; p<0.001), decreased sPAP (43.1 ± 11.6 mm Hg vs 37.1 ± 7.7 mm Hg; p<0.001) and increased LVEF in those with EF ≤ 40% (34.9 ± 6% vs 43.5 ± 14.4%; p=0.006). Concerning QOL, 49% walked unassisted, 79% (39.5% among pts ≥ 85 years) reported self-awareness improvement; QOL was reported as "good" in 58% (31.4% among pts ≥ 85 years), "acceptable according to age" in 34% (16% among pts ≥ 85 years) and "bad" in 8%.
  
  
  CONCLUSIONS
  TAVI procedures improve clinical outcome and subjective health-related QOL in very elderly patients with symptomatic AS.
authors.affiliation: Cardiovascular and Thoracic Department, San Raffaele Scientific Institute and Università Vita-Salute, Milan, Italy. grimaldi.antonio@hsr.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.forename: Pietro
authors.initials: P
authors.lastname: Spagnolo
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Vermi
authors.forename: Santo
authors.initials: S
authors.lastname: Ferrarello
authors.forename: Daniela
authors.initials: D
authors.lastname: Piraino
authors.forename: Valeria
authors.initials: V
authors.lastname: Cammalleri
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Sacco
authors.forename: Iryna
authors.initials: I
authors.lastname: Arendar
authors.forename: Egidio
authors.initials: E
authors.lastname: Collu
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Aortic stenosis; Quality of life; TAVI