Short- and mid-term outcome of transcatheter aortic valve implantation in patients with advanced age
Abstract
Background: In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one of the most important risk factors. The aim of our study was to evaluate whether early and mid-term results of TAVI were worse in patients over 85 year old compared with the younger population.
Methods: From September 2010 to November 2015, 162 consecutive patients (mean age 78.4 ± 7.1 years, 47.5% females) underwent TAVI in our Institution. Patients were divided into two groups: 1) elderly (≥ 85 year old) and 2) younger patients (< 85 year old). Primary clinical study endpoints were the following: death, myocardial infarction, stroke, major and minor access site, and bleeding complications. The secondary endpoints included: pacemaker implantation rate, paravalvular leakage, acute kidney injury, and duration of hospitalization. Results: Twenty-six patients were 85 or older (mean 87.5 ± 2.1). In the remaining 136 (84%), the average age was 76.7 ± 6.4. Baseline clinical profiles were similar in both groups, though history of previous cardiac surgery (p = 0.0047) and chronic obstructive pulmonary disease (p = 0.0099) were more common in the younger group, and glomerular filtration rate was lower in the older group (p = 0.045). Major, life threatening and minor bleeding complications, as well as vascular access site complications did not differ between the two groups. Rates of myocardial infarction and stroke were comparably low in both groups. Similar results were also found in the incidence of secondary endpoints. In-hospital mortality and 1-year mortality did not differ between groups.
Conclusions: TAVI in patients aged 85 and older is still a relatively safe procedure and age itself should not be a discriminatory factor in TAVI qualification. (Cardiol J 2017; 24, 4: 358–363)
Keywords: aortic stenosisagetranscatheter aortic valve implantation (TAVI)
References
- Windecker S, Kolh P, Alfonso F, et al. Authors/Task Force members. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35(37): 2541–2619.
- Kappetein AP, Head SJ, Genereux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothoracic Surg, 2012; 42(5): S45–S60.
- Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2005; 26(24): 2714–2720.
- Alsara O, Alsarah A, Laird-Fick H. Advanced age and the clinical outcomes of transcatheter aortic valve implantation. J Geriatr Cardiol. 2014; 11(2): 163–170.
- Thyregod HG, Holmberg F, Gerds TA, et al. Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis. Scand Cardiovasc J. 2016; 50(3): 146–153.
- Eggebrecht H, Mehta RH. Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly? EuroIntervention. 2016; 11(9): 1029–1033.
- Leon MB, Smith CR, Mack M, et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17): 1597–1607.
- Holmes DR, Nishimura RA, Grover FL, et al. STS/ACC TVT Registry. Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry. J Am Coll Cardiol. 2015; 66(25): 2813–2823.
- Abramowitz Y, Chakravarty T, Jilaihawi H, et al. Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ≥90 Years Versus <90 Years. Am J Cardiol. 2015; 116(7): 1110–1115.
- Bekeredjian R, Krumsdorf U, Chorianopoulos E, et al. Usefulness of percutaneous aortic valve implantation to improve quality of life in patients >80 years of age. Am J Cardiol. 2010; 106(12): 1777–1781.
- Olsen S, Fridlund B, Eide L, et al. Changes in self-reported health and quality of life in octogenarian patients one month after transcatheter aortic valve implantation. Eur J Cardiovasc Nurs. 2017; 16(1): 79–87.
- Barbanti M, Capranzano P, Ohno Y, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart. 2015; 101(18): 1485–1490.
- Durand E, Eltchaninoff H, Canville A, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol. 2015; 115(8): 1116–1122.
- Havakuk O, Finkelstein A, Steinvil A, et al. Comparison of outcomes in patients ≤85 versus >85 years of age undergoing transcatheter aortic-valve implantation. Am J Cardiol. 2014; 113(1): 138–141.
- Yamamoto M, Meguro K, Mouillet G, et al. Comparison of effectiveness and safety of transcatheter aortic valve implantation in patients aged ≥90 years versus <90 years. Am J Cardiol. 2012; 110(8): 1156–1163.