Original title: Comparison of Outcomes of Transcathether Aortic Valve Implantation in Patients ≥90 Years Versus <90 Years.
Reference: Yigal Abramowitz, et al. Am J Cardiol 2015;116:1110-1115.
More and more 90 year old patients require transcatheter aortic valve replacement (TAVI); however, its benefits have not been studied in this particular population.
This study enrolled 734 patients undergoing TAVI with the balloon expandable valve (Edwards Sapiens) in one center. It compared the outcomes of 136 patients aged ≥90 at the time of procedure (mean age was 92.4 ± 2.4 years) against the remaining 598 younger patients (mean age, 79.7 ± 7.8 years).
The femoral access site was used most often; procedural success was 96% and in-hospital stay reached a mean 5.3 days for the global population.
At 30 days, mortality rate was similar between both groups (2.9% vs. 2.8% respectively; p= 0.95) as well as mortality at one year (12.5% vs. 12.3% respectively; p=0.95).
The ≥90 group presented more minor vascular complications (13.2% vs. 7.7%; p= 0.04), being this the only significant difference between the groups.
Mortality predictors in both cohorts were diabetes, chronic kidney disease, atrial fibrillation and the use of an access site other than the femoral.
Conclusion
TAVI with balloon expandable prosthesis in appropriately selected ≥90 patients is feasible and offers clinical benefits similar to those expected from a younger population. Advanced age in the absence of significant comorbidities should not be a reason to exclude patients with severe aortic stenosis from TAVI.
Editorial Comment
This analysis shows that it is possible to improve the quality of life and lifespan of selected nonagenarian patients given the similar results, at one year, to those of younger patients.
A longer follow up is needed, since survival is more limited in this group than in the general population.
Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Argentina