Original Title: Should Transcatheter Aortic valve replacement Be Performed in Nonagenarians? Insights from the STS/ACC TVT Registry. Reference: Mani Arsalan et al. J Am Coll Cardiol. 2016 Mar 29;67(12):1387-95.
Courtesy of Dr. Carlos Fava
The benefit of the transcatheter aortic valve replacement (TAVI) has already been shown in the general population undergoing this procedure. The number of patients over 90 is growing and there is little information available on whether they too will benefit from TAVI at the same extent younger patients do.
The study analyzed TAVI outcomes of 3773 patients ≥90 and 20252 patients <90 at 30 days and 1 year.
Mean age in the first group was 92, and 82 in the second. In the ≥90 group, there were more women, less non cardiac vascular surgery, and less stroke and prior infarction, but there was higher risk of surgical death (STS PROM 9.2% vs. 6.3%; p<0.001).
At in-hospital evolution, the ≥90 group presented more stroke, vascular complications, bleeding, transfusions, more days in intensive care and more death (6.5% vs. 4.5% p<0.001).
At 30 days and one year, there were no differences in stroke, reintervention or AMI rates. Rehospitalization for heart failure was more frequent among nonagenarians at 30 days, but at one year it was the same in both groups.
Mortality was higher among ≥90, (30 days 8.8% vs. 5.9%; p<0.001 and at one year 24.8% vs. 22%; p<0.001, absolute risk 2.8%, relative risk 12.7%).
There were also 15 ≥100 year old patients; not one of them died at 30 days and mortality at one year was 6.7%.
After adjusting by demographic variables, patients ≥90 continued to show a higher rate of heart failure at 30 days and a higher rate of death at 30 days and one year.
Quality of life in this group was lower at 30 days but similar at 12 months, compared to younger patients.
Conclusion
In the daily practice, around 16% of patients undergoing TAVI are ≥90. Even though mortality at 30 days and one year is higher compared mortality in younger patients, absolute and relative differences were modest. TAVI improves quality of life in this group, as well as in younger patients. These data support the safety and efficacy of TAVI in very elderly patients.
Editorial Comment
This is the largest analyzis on the evolution of this age group; it shows that TAVI in nonagenarians not only is feasible and safe, but also improves quality of life to the same degree as in younger patients.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Buenos Aires