title: Outcomes of Treatment of Nonagenarians With Severe Aortic Stenosis.
abstract: BACKGROUND
  Because nonagenarians with aortic stenosis (AS) often present as frail with more comorbid conditions, long-term outcomes and quality of life are important treatment considerations. The aim of this report is to describe survival and functional outcomes of nonagenarians undergoing treatment for AS by surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  This is a retrospective analysis of all patients aged 90 years or more undergoing treatment for AS between 2007 and 2013 at two centers. Outcomes were compared between SAVR and TAVR. Long-term survival was compared with an age- and sex-matched population from the Social Security Actuarial Life Table.
  
  
  RESULTS
  In all, 110 patients underwent treatment for isolated AS (20 SAVR and 90 TAVR). Mean age was 91.85 ± 1.80 years, and 50.9% were female. The Society of Thoracic Surgeons mean predicted risk of mortality was 11.11% ± 5.74%. Operative mortality was 10.9% (10.0% SAVR; 11.1% TAVR); 2.7% of patients had a stroke. The TAVR patients were more likely to be discharged home (75.9% versus 55.6% for SAVR, p = 0.032). Mean follow-up was 1.8 ± 1.5 years, with a 1-year and 5-year survival of 78.7% and 45.3%, respectively, which approximated the US actuarial survival. There was a significant improvement in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire at 1 year compared with baseline.
  
  
  CONCLUSIONS
  Treatment of AS approximates natural life expectancy in select nonagenarians, with no significant difference in long-term survival between SAVR and TAVR. Importantly, patient quality of life improved at 1 year. With appropriate selection, nonagenarians with severe AS can benefit from treatment.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Molly Claire
authors.initials: MC
authors.lastname: Mack
authors.affiliation: Department of Cardiology, Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Molly
authors.initials: M
authors.lastname: Szerlip
authors.affiliation: Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Morley A
authors.initials: MA
authors.lastname: Herbert
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Siddique
authors.initials: S
authors.lastname: Akram
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Christina
authors.initials: C
authors.lastname: Worley
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Rebeca J
authors.initials: RJ
authors.lastname: Kim
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Prince
authors.affiliation: Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Harrington
authors.affiliation: Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas. Electronic address: eholper@gmail.org.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome