title: Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature.
abstract: The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 % of patients. Paravalvular regurgitation was observed in 57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access complication 8.8 %, and permanent pacemaker implantation 10.6 %. Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy. paola.derrigo@iss.it.
authors.forename: Paola
authors.initials: P
authors.lastname: D'Errigo
authors.affiliation: National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosato
authors.affiliation: First Faculty of Medicine, Institute of Anatomy, Charles University in Prague, Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Pol
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia, ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.affiliation: National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Seccareccia
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D015201:Meta-Analysis as Topic; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: 90 years; Aortic valve stenosis; Nonagenarian; TAVI; TAVR; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement