title: Clinical profiles and correlates of mortality in nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve replacement.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) is the current standard for nonoperable and high-risk surgical patients with aortic stenosis, including those of advanced age. However, the clinical profiles, procedural characteristics, and outcomes of nonagenarians undergoing TAVR have not been thoroughly reported.
  
  
  METHODS
  A total of 654 patients (n = 107 >90 years old and n = 547 <90 years) with severe aortic stenosis undergoing TAVR were included in this analysis. Baseline characteristics, procedural variables, and in-hospital outcomes and complications at 30 days and 12 months were analyzed.
  
  
  RESULTS
  Overall, of the patients included, 46% were high risk and 53% inoperable. Although nonagenarians had a higher Society of Thoracic Surgeons score of 9.2 ± 4 (12.1 ± 4 vs 8.6 ± 4, P < .001), other factors were considerably lower in this group: diabetes (22% vs 36%, P = .008), hyperlipidemia (65% vs 83%, P < .001), prior coronary artery bypass (13% vs 39%, P < .001), and mean body mass index (24.5 ± 5 vs 28.1 ± 7 kg/m(2), P < .001). The correlates for 1-year mortality in nonagenarians were as follows: ≥moderate aortic insufficiency post-TAVR (hazard ratio [HR] 5.07, 95% CI 1.17-22, P = .03), pacemaker implantation after TAVR (HR 6.87, 95% CI 2.32-20.3, P = .001), and peripheral vascular disease (HR 2.35, 95% CI 1.03-5.38, P = .042). Mortality at 30 days (12.1% vs 7.1%, P = .07) and at 1 year (25% vs 21%, P = .35) was similar between groups.
  
  
  CONCLUSIONS
  Nonagenarians undergoing TAVR had a healthier clinical profile compared with younger patients. Age alone should not be a discriminatory factor when screening elderly patients with aortic stenosis because even the nonagenarians are doing well when compared with the younger elderly population. Transcatheter aortic valve replacement remains a viable option for the treatment of severe symptomatic aortic stenosis for the elderly regardless of their age.
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escárcega
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Gai
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Section of Interventional Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D017023:Coronary Angiography; D003952:Diagnostic Imaging / Q000379:methods*; D004219:District of Columbia / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement