Safe for 80-Year-Olds. Should Nonagenarians be Withheld from TAVR?

According to this large global registry, mortality after transcatheter aortic valve replacement (TAVR) is twice as high in nonagenarians as against the “younger” group (<90) despite their lower prevalence of comorbidities at baseline.

Estenosis aórtica severa asintomática en añosos: ¿cuándo intervenir?

Moreover, nonagenarians present higher risk of stroke, major or life-threatening bleeding and new atrial fibrillation. The STS-PROM is the only surgical risk score that can predict mortality risk in this group.

The prevalence of aortic stenosis is increasing along with life expectancy. In this regard, there is little information on the evolution of our >90 patients. Additionally, risk scores cannot be trusted given that on the one hand they were designed for patients with planned surgery, and on the other hand, they included few patients this old.

The CENTER (Cerebrovascular EveNts in Patients Undergoing TranscathetER Aortic Valve Implantation) was a collaborative study including 12381 patients with registries from 3 countries, 6 multicenter registries and one prospective clinical study.


Read also: Mortality and Paclitaxel Devices, Data Are Aligning.


Primary end point was the difference in 30-day mortality and stroke after TAVR in nonagenarian vs. younger patients. Secondary end points included baseline characteristics, inhospital outcomes and the differences in accurate prediction of events from the EuroSCORE log, the EuroSCORE II and the STS-PROM in this special population.

A total 882 nonagenarian patients and 11499 sub-90 undergoing transfemoral TAVR were included between 2017 and 2018.

Nonagenarian presented significantly fewer comorbidities than the younger cohort.

In spite of that, mortality rate at 30 days resulted nearly twice as high in nonagenarians (9.9% vs. 5.4%; RR: 1.8; CI 95% 1.4 to 2.3; p=0.001), as was inhospital stroke (3.0% vs. 1.9%; RR: 1.5; CI 95% 1.0 to 2.3; p=0.04), major or life threatening bleeding (8.1% vs. 5.5%; RR: 1.6; CI 95% 1.1 to 2.2; p=0.004) and the development of new atrial fibrillation (7.9% vs. 5.2%; RR: 1.6; CI 95% 1.1 to 2.2; p=0.01).


Read also: Outpatient Rhythm Monitoring After TAVR Could Save Us from Some Pacemakers?


The only score that adequately estimated mortality risk in this special group (with observed to expected mortality ratio equal to 1.0) was the STS-PROM.

However, being over 90 is no reason to withhold patients from any procedure, and we have known since the first PARTNER what medical treatment results in.

It is vital for patients to be assessed by the “Heart Team”, and for them to determine if their life expectancy is longer than 1 year. In this case, there is no reason to withhold nonagenarian patients from TAVR.

Original title: Transfemoral TAVR in Nonagenarians.

Reference: Wieneke Vlastra et al. J Am Coll Cardiol Intv 2019;12:911–20.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...

TAVI and Hypertrophic Cardiomyopathy: An Increasingly Common Association

Stenosis is a common disease affecting 5% of the elderly population. It is associated with hospitalizations, poor quality of life, and mortality.  The association between...

TAVR in Bicuspid Valves: Higher Prosthesis Mismatch?

TAVR indication is steadily advancing onto younger, lower risk patients.  The presence of bicuspid aortic valves (BAV) has been observed in 0.5% to 2% of...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

Intravascular Lithotripsy in Calcified Coronary Lesions: Success Predictors

Coronary artery calcification (CAC) is increasingly common in patients undergoing percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has been established as an effective tool...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...