Short- and mid-term results after transapical transcatheter aortic valve replacement in nonagenarians.
BACKGROUND
Recent reports have suggested that advanced age may preclude favorable outcomes in transcatheter aortic valve replacement (TAVR), particularly when performed via transapical (TA) access. However, detailed examinations of TA-TAVR in nonagenarian patients are lacking in the contemporary literature. We therefore describe our experience with 25 consecutive nonagenarians who underwent TA-TAVR and report their short- and mid-term outcomes.


METHODS
We identified all patients 90 years old or greater who underwent TA-TAVR between 2009-2014 at our institution. Demographic, comorbidity and echocardiographic data were obtained for all patients as were their in-hospital, 30-day, and 1-year outcomes. Overall survival was calculated using the Kaplan-Meier method.


RESULTS
The mean Society of Thoracic Surgeons' predicted risk of mortality was 10.2% (SD±3.4). Twenty-four nonagenarians received TA-TAVR secondary to severe aortic stenosis while 1 had a valve-in-valve procedure for a regurgitant bioprosthetic valve. There were no conversions to open surgery, no aborted procedures, and no in-hospital deaths or strokes; 44% of patients (N.=11) were discharged to home. Five patients required cardiac rehospitalization within the first 30 days and 2 experienced strokes during the first year. Overall 30-day and 1-year survival were 100% and 83%, respectively.


CONCLUSIONS
TA-TAVR can safely be performed on nonagenarians subjected to otherwise standard selection criteria. Chronology should not stand as a routine contraindication to this procedure; rather, comorbidities and functional status should define patient eligibility for TA-TAVR.
Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Andreas R
AR
DE Biasi
Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
S Chiu
SC
Wong
Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Robert M
RM
Minutello
Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Konstantinos
K
Voudris
Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Berhane
B
Worku
Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Leonard N
LN
Girardi
Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA - ars9001@med.cornell.edu.
Arash
A
Salemi
D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009519:New York City; D010359:Patient Readmission; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome