title: Isolated aortic valve replacement in octogenarians before and after the introduction of trans-catheter aortic valve implantation.
abstract: BACKGROUND
  Trans-catheter aortic valve implantation (TAVI) became available at Auckland City Hospital in 2011 for patients with severe aortic stenosis in whom surgical aortic valve replacement (AVR) was deemed at high risk. We assessed whether introduction of TAVI affected the characteristics and outcomes of octogenarians undergoing AVR.
  
  
  METHODS
  Isolated AVR performed in patients ≥80 years of age during 2008-2012 were divided into two groups, pre- and post-TAVI introduction, for analyses.
  
  
  RESULTS
  Isolated AVR was undertaken in 35 and 33 octogenarians pre- and post-TAVI introduction. The post-TAVI group were older (84.2 vs 82.3 years, P=0.003), had lower ejection fraction (P=0.026), more had inpatient surgery (76% vs 29%, P<0.001), with higher EuroSCORE II (5.4 vs 3.9%, P=0.033). Operative mortality was 0.0% in both groups. One-year survival was similar (97.6% vs 94.3%, P=0.613), but composite morbidity was lower in the post-TAVI group (9.1% vs 31.4%, P=0.035). Chronic respiratory disease (P=0.043) independently predicted mortality during follow-up, while number of coronary vessel>50% stenosis (P=0.050), creatinine clearance (P=0.016) and being in the pre-TAVI era group (P=0.022) predicted composite morbidity.
  
  
  CONCLUSIONS
  Since TAVI was introduced, mean age and risk scores significantly increased in octogenarians undergoing AVR, while mortality rates remained similar and composite morbidity decreased.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. Electronic address: TWang@adhb.govt.nz.
authors.forename: Tom Kai Ming
authors.initials: TK
authors.lastname: Wang
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Janarthanan
authors.initials: J
authors.lastname: Sathananthan
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Tharumenthiran
authors.initials: T
authors.lastname: Ramanathan
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Webster
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Ruygrok
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Age; Aortic stenosis; Aortic valve replacement; Geriatric; Transcatheter aortic valve implantation