title: Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ≥90 Years Versus <90 Years.
abstract: Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is increasingly performed in nonagenarians. There is scarce evidence on the feasibility and safety of balloon-expandable TAVI in this patient population. A total of 734 patients who underwent balloon-expandable TAVI at our institute were included in the study. We compared 136 patients who were aged at least 90 years at the time of TAVI (mean age 92.4 ± 2.4 years) with the remaining 598 younger patients (mean age 79.7 ± 7.8 years). Valve Academic Research Consortium 2 end points were compared between the 2 groups. Diabetes mellitus, coronary artery disease (CAD), peripheral artery disease (PAD), and chronic lung disease were significantly less prevalent in patients aged ≥90 years. In contrast, the prevalence of frailty, chronic renal failure, and atrial fibrillation was significantly higher in these patients. Device success was 96% in both groups. All-cause mortality at 30 days and 1 year was 2.9% and 12.5% versus 2.8% and 12.3% in patients aged ≥90 and <90, respectively (p = 0.95 for both). All major complication rates were similar between groups. Nonagenarians had higher rates of minor vascular complications (13.2% vs 7.7%; p = 0.04). In conclusion, performing balloon-expandable TAVI in carefully selected group of nonagenarians is feasible and offers clinical benefit comparable to patients aged <90 years. Advanced age, in the absence of significant co-morbidities, should not deter clinicians from evaluating patients for TAVI for severe AS.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Ronit
authors.initials: R
authors.lastname: Zadikany
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Chin
authors.initials: C
authors.lastname: Lee
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: George
authors.initials: G
authors.lastname: Matar
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: Raj.Makkar@cshs.org.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002140:California / Q000453:epidemiology; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome