Clinical profiles and correlates of mortality in nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve replacement

Ricardo O. Escárcega, Nevin C. Baker, Michael J. Lipinski, Edward Koifman, Sarkis Kiramijyan, Marco A. Magalhaes, Jiaxiang Gai, Rebecca Torguson, Lowell F. Satler, Augusto D. Pichard, Ron Waksman

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background Transcatheter aortic valve replacement (TAVR) is the current standard for nonoperable and high-risk surgical patients with aortic stenosis, including those of advanced age. However, the clinical profiles, procedural characteristics, and outcomes of nonagenarians undergoing TAVR have not been thoroughly reported. Methods A total of 654 patients (n = 107 >90 years old and n = 547 <90 years) with severe aortic stenosis undergoing TAVR were included in this analysis. Baseline characteristics, procedural variables, and in-hospital outcomes and complications at 30 days and 12 months were analyzed. Results Overall, of the patients included, 46% were high risk and 53% inoperable. Although nonagenarians had a higher Society of Thoracic Surgeons score of 9.2 ± 4 (12.1 ± 4 vs 8.6 ± 4, P <.001), other factors were considerably lower in this group: diabetes (22% vs 36%, P =.008), hyperlipidemia (65% vs 83%, P <.001), prior coronary artery bypass (13% vs 39%, P <.001), and mean body mass index (24.5 ± 5 vs 28.1 ± 7 kg/m2, P <.001). The correlates for 1-year mortality in nonagenarians were as follows: ≥moderate aortic insufficiency post-TAVR (hazard ratio [HR] 5.07, 95% CI 1.17-22, P =.03), pacemaker implantation after TAVR (HR 6.87, 95% CI 2.32-20.3, P =.001), and peripheral vascular disease (HR 2.35, 95% CI 1.03-5.38, P =.042). Mortality at 30 days (12.1% vs 7.1%, P =.07) and at 1 year (25% vs 21%, P =.35) was similar between groups. Conclusion Nonagenarians undergoing TAVR had a healthier clinical profile compared with younger patients. Age alone should not be a discriminatory factor when screening elderly patients with aortic stenosis because even the nonagenarians are doing well when compared with the younger elderly population. Transcatheter aortic valve replacement remains a viable option for the treatment of severe symptomatic aortic stenosis for the elderly regardless of their age.

Original languageEnglish
Pages (from-to)118-125
Number of pages8
JournalAmerican Heart Journal
Volume173
DOIs
StatePublished - 1 Mar 2016
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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