title: Outcomes for Transcatheter Aortic Valve Replacement in Nonagenarians.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) may offer extreme-aged patients a treatment alternative to surgical aortic valve replacement (SAVR). The objective of this study was to describe outcomes of TAVR in nonagenarians using transfemoral and alternative access techniques.
  
  
  METHODS
  In a retrospective review, we found 95 nonagenarians who underwent TAVR from September 2007 through February 2014 at Emory University using a balloon expandable valve: transfemoral (n = 66), transapical (n = 14), transaortic (n = 14), and transcarotid (n = 1). Morbidity and 30-day and midterm mortality were assessed. Kaplan-Meier plots were used to determine midterm survival rates.
  
  
  RESULTS
  The mean age of the patients was 91.8 ± 1.8 years, and 49 (52%) were female. Postoperative morbidity included 1 patient (1%) each with stroke, myocardial infarction, pneumonia, and renal failure. The mean postoperative length of stay was 6.8 ± 5.1 days for all patients. Overall 30-day mortality was 3.2%, much less than The Society of Thoracic Surgeons predicted risk of mortality of 14.5% ± 7.3%. There were no deaths in the transfemoral patients, but there were 2 transapical deaths (14.3%) and 1 transaortic death (7.1%). The Kaplan-Meier estimate of median survival was 2.6 years.
  
  
  CONCLUSIONS
  Extreme-aged nonagenarian patients may have excellent outcomes from TAVR at 30-day and midterm follow-up. Alternative access TAVR is associated with higher morbidity and mortality than transfemoral TAVR. Referral for TAVR of nonagenarians should not be precluded based on age alone.
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Kayatta
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia. Electronic address: vthoura@emory.edu.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Hanna A
authors.initials: HA
authors.lastname: Jensen
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Condado
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Sarin
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Kilgo
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Chandan M
authors.initials: CM
authors.lastname: Devireddy
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Leshnower
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Kreton
authors.initials: K
authors.lastname: Mavromatis
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Chun
authors.initials: C
authors.lastname: Li
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: James P
authors.initials: JP
authors.lastname: Stewart
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Amy
authors.initials: A
authors.lastname: Simone
authors.affiliation: Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Keegan
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Peter
authors.initials: P
authors.lastname: Block
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Vasilis C
authors.initials: VC
authors.lastname: Babaliaros
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007902:Length of Stay; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality; D016896:Treatment Outcome