title: Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve Replacement in the PARTNER-I Trial.
abstract: BACKGROUND
  This study describes short-term and mid-term outcomes of nonagenarian patients undergoing transfemoral or transapical transcatheter aortic valve replacement (TAVR) in the Placement of Aortic Transcatheter Valve (PARTNER)-I trial.
  
  
  METHODS
  From April 2007 to February 2012, 531 nonagenarians, mean age 93 ± 2.1 years, underwent TAVR with a balloon-expandable prosthesis in the PARTNER-I trial: 329 through transfemoral (TF-TAVR) and 202 transapical (TA-TAVR) access. Clinical events were adjudicated and echocardiographic results analyzed in a core laboratory. Quality of life (QoL) data were obtained up to 1 year post-TAVR. Time-varying all-cause mortality was referenced to that of an age-sex-race-matched US population.
  
  
  RESULTS
  For TF-TAVR, post-procedure 30-day stroke risk was 3.6%; major adverse events occurred in 35% of patients; 30-day paravalvular leak was greater than moderate in 1.4%; median post-procedure length of stay (LOS) was 5 days. Thirty-day mortality was 4.0% and 3-year mortality 48% (44% for the matched population). By 6 months, most QoL measures had stabilized at a level considerably better than baseline, with Kansas City Cardiomyopathy Questionnaire (KCCQ) 72 ± 21. For TA-TAVR, post-procedure 30-day stroke risk was 2.0%; major adverse events 32%; 30-day paravalvular leak was greater than moderate in 0.61%; and median post-procedure LOS was 8 days. Thirty-day mortality was 12% and 3-year mortality 54% (42% for the matched population); KCCQ was 73 ± 23.
  
  
  CONCLUSIONS
  A TAVR can be performed in nonagenarians with acceptable short- and mid-term outcomes. Although TF- and TA-TAVR outcomes are not directly comparable, TA-TAVR appears to carry a higher risk of early death without a difference in intermediate-term mortality. Age alone should not preclude referral for TAVR in nonagenarians.
authors.affiliation: Emory University, Atlanta, Georgia. Electronic address: vthoura@emory.edu.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Hanna A
authors.initials: HA
authors.lastname: Jensen
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Ehrlinger
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Creighton W
authors.initials: CW
authors.lastname: Don
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Aldea
authors.affiliation: New York University, Langone Medical Center, New York, New York.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: James M
authors.initials: JM
authors.lastname: McCabe
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Larry S
authors.initials: LS
authors.lastname: Dean
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Chandan
authors.initials: C
authors.lastname: Devireddy
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Leshnower
authors.affiliation: University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: Washington University, St. Louis, Missouri.
authors.forename: Hersh S
authors.initials: HS
authors.lastname: Maniar
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Baylor, Scott & White Health, Plano, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome