Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up.
OBJECTIVE
To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS).


METHODS
This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years.


RESULTS
The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality.


CONCLUSIONS
TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.
Area del Corazón, Hospital Universitario Central de Asturias, Av. Roma, Oviedo, Asturias, Spain.
Isaac
I
Pascual
Department of Cardiology, Hospital Universitario Vírgen de la Victoria, Campus de Teatinos, Málaga, Spain.
Antonio J
AJ
Muñoz-García
Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, A Coruña, Spain.
Diego
D
López-Otero
Area del Corazón, Hospital Universitario Central de Asturias, Av. Roma, Oviedo, Asturias, Spain.
Pablo
P
Avanzas
Department of Cardiology, Hospital Universitario Vírgen de la Victoria, Campus de Teatinos, Málaga, Spain.
Manuel F
MF
Jimenez-Navarro
Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, A Coruña, Spain.
Belén
B
Cid-Alvarez
Area del Corazón, Hospital Universitario Central de Asturias, Av. Roma, Oviedo, Asturias, Spain.
Raquel
R
Del Valle
Department of Cardiology, Hospital Universitario Vírgen de la Victoria, Campus de Teatinos, Málaga, Spain.
Juan H
JH
Alonso-Briales
Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, A Coruña, Spain.
Raimundo
R
Ocaranza-Sanchez
Department of Cardiology, Hospital Universitario Vírgen de la Victoria, Campus de Teatinos, Málaga, Spain.
José M
JM
Hernández
Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, A Coruña, Spain.
Ramiro
R
Trillo-Nouche
Area del Corazón, Hospital Universitario Central de Asturias, Av. Roma, Oviedo, Asturias, Spain.
César
C
Morís
Aortic stenosis; High surgical risk; Transcatheter aortic valve; Very elderly patients