Advertisement

Comparison of Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients Aged ≥90 Years Versus <90 Years

      In a fraction of patients aged ≥90 years, less-invasive transcatheter aortic valve implantation (TAVI) has been considered a therapeutic option for aortic stenosis under careful clinical screening. However, the safety and effectiveness using TAVI in such a population has not been fully elucidated. The aim of the present study was to investigate the feasibility of TAVI in nonagenarians. We prospectively enrolled 136 consecutive patients with severe aortic stenosis who were referred for TAVI. The procedural, early, and midterm clinical outcomes were compared between patients aged <90 years (n = 110, average age 82.3 ± 8.3 years) and ≥90 years (n = 26; average age 91.6 ± 1.9 years). A comparison of the baseline characteristics revealed that among patients aged ≥90 years, the prevalence of women (50% vs 81%, p <0.001) and the mean aortic valve gradient (45.5 ± 15.4 vs 56.3 ± 23.4 mm Hg, p = 0.005) were greater than those in patients aged <90 years. Major vascular complications occurred more frequently in patients ≥90 years (5% vs 19%, p = 0.022), although the rate of procedural success and 30-day and 6-month mortality were not different between the 2 age groups (96% vs 100%, p = 0.58; 6% vs 15%, p = 0.22; and 14% vs 27%, p = 0.14, respectively). The mortality rates were greater among patients aged ≥90 years. At 6 months, both groups of survivors were similar in symptom status, with a New York Heart Association classification less than class II (89% vs 84%, p = 0.68). The cumulative survival (median 13.4 ± 8.0 months of follow-up) was not significantly different between the 2 age groups (p = 0.22, log-rank test). In conclusion, even very elderly nonagenarians can experience acceptable clinical results and benefits after TAVI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dunning J.
        • Gao H.
        • Chambers J.
        • Moat N.
        • Murphy G.
        • Pagano D.
        • Ray S.
        • Roxburgh J.
        • Bridgewater B.
        Aortic valve surgery: marked increases in volume and significant decreases in mechanical valve use—an analysis of 41,227 patients over 5 years from the society for cardiothoracic surgery in Great Britain and Ireland national database.
        J Thorac Cardiovasc Surg. 2011; 142: 776-782
        • Melby S.J.
        • Zierer A.
        • Kaiser S.P.
        • Guthrie T.J.
        • Keune J.D.
        • Schuessler R.B.
        • Pasque M.K.
        • Lawton J.S.
        • Moazami N.
        • Moon M.R.
        • Damiano Jr, R.J.
        Aortic valve replacement in octogenarians: risk factors for early and late mortality.
        Ann Thorac Surg. 2007; 83: 1651-1656
        • de Vincentiis C.
        • Kunkl A.B.
        • Trimarchi S.
        • Gagliardotto P.
        • Frigiola A.
        • Menicanti L.
        • Di Donato M.
        Aortic valve replacement in octogenarians: is biologic valve the unique solution?.
        Ann Thorac Surg. 2008; 85: 1296-1301
        • Di Eusanio M.
        • Fortuna D.
        • De Palma R.
        • Dell'Amore A.
        • Lamarra M.
        • Contini G.A.
        • Gherli T.
        • Gabbieri D.
        • Ghidoni I.
        • Cristell D.
        • Zussa C.
        • Pigini F.
        • Pugliese P.
        • Pacini D.
        • Di Bartolomeo R.
        Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients.
        J Thorac Cardiovasc Surg. 2011; 141: 940-947
        • Florath I.
        • Albert A.
        • Boening A.
        • Ennker I.C.
        • Ennker J.
        Aortic valve replacement in octogenarians: identification of high-risk patients.
        Eur J Cardiothorac Surg. 2010; 37: 1304-1310
        • Langanay T.
        • Flécher E.
        • Fouquet O.
        • Ruggieri V.G.
        • De La Tour B.
        • Félix C.
        • Lelong B.
        • Verhoye J.P.
        • Corbineau H.
        • Leguerrier A.
        Aortic valve replacement in the elderly: the real life.
        Ann Thorac Surg. 2012; 93: 70-77
        • Cribier A.
        • Eltchaninoff H.
        • Bash A.
        • Borenstein N.
        • Tron C.
        • Bauer F.
        • Derumeaux G.
        • Anselme F.
        • Laborde F.
        • Leon M.B.
        Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.
        Circulation. 2002; 106: 3006-3008
        • Grube E.
        • Schuler G.
        • Buellesfeld L.
        • Gerckens U.
        • Linke A.
        • Wenaweser P.
        • Sauren B.
        • Mohr F.W.
        • Walther T.
        • Zickmann B.
        • Iversen S.
        • Felderhoff T.
        • Cartier R.
        • Bonan R.
        Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome.
        J Am Coll Cardiol. 2007; 50: 69-76
        • Webb J.G.
        • Pasupati S.
        • Humphries K.
        • Thompson C.
        • Altwegg L.
        • Moss R.
        • Sinhal A.
        • Carere R.G.
        • Munt B.
        • Ricci D.
        • Ye J.
        • Cheung A.
        • Lichtenstein S.V.
        Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis.
        Circulation. 2007; 116: 755-763
        • Rodés-Cabau J.
        • Webb J.G.
        • Cheung A.
        • Ye J.
        • Dumont E.
        • Feindel C.M.
        • Osten M.
        • Natarajan M.K.
        • Velianou J.L.
        • Martucci G.
        • Devarennes B.
        • Chisholm R.
        • Peterson M.D.
        • Lichtenstein S.V.
        • Nietlispach F.
        • Doyle D.
        • Delarochellière R.
        • Teoh K.
        • Chu V.
        • Dancea A.
        • Lachapelle K.
        • Cheema A.
        • Latter D.
        • Horlick E.
        Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience.
        J Am Coll Cardiol. 2010; 55: 1080-1090
        • Buellesfeld L.
        • Wenaweser P.
        • Gerckens U.
        • Mueller R.
        • Sauren B.
        • Latsios G.
        • Zickmann B.
        • Hellige G.
        • Windecker S.
        • Grube E.
        Transcatheter aortic valve implantation: predictors of procedural success—the Siegburg-Bern experience.
        Eur Heart J. 2010; 31: 984-991
        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • Tuzcu E.M.
        • Webb J.G.
        • Fontana G.P.
        • Makkar R.R.
        • Brown D.L.
        • Block P.C.
        • Guyton R.A.
        • Pichard A.D.
        • Bavaria J.E.
        • Herrmann H.C.
        • Douglas P.S.
        • Petersen J.L.
        • Akin J.J.
        • Anderson W.N.
        • Wang D.
        • Pocock S.
        • PARTNER Trial Investigators
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • Tuzcu E.M.
        • Webb J.G.
        • Fontana G.P.
        • Makkar R.R.
        • Williams M.
        • Dewey T.
        • Kapadia S.
        • Babaliaros V.
        • Thourani V.H.
        • Corso P.
        • Pichard A.D.
        • Bavaria J.E.
        • Herrmann H.C.
        • Akin J.J.
        • Anderson W.N.
        • Wang D.
        • Pocock S.J.
        • PARTNER Trial Investigators
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Vahanian A.
        • Alfieri O.
        • Al-Attar N.
        • Antunes M.
        • Bax J.
        • Cormier B.
        • Cribier A.
        • De Jaegere P.
        • Fournial G.
        • Kappetein A.P.
        • Kovac J.
        • Ludgate S.
        • Maisano F.
        • Moat N.
        • Mohr F.
        • Nataf P.
        • Piérard L.
        • Pomar J.L.
        • Schofer J.
        • Tornos P.
        • Tuzcu M.
        • van Hout B.
        • von Segesser L.K.
        • Walther T.
        • European Association of Cardio-Thoracic Surgery, European Society of Cardiology, European Association of Percutaneous Cardiovascular Interventions
        Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
        Eur Heart J. 2008; 29: 1463-1470
        • Leon M.B.
        • Piazza N.
        • Nikolsky E.
        • Blackstone E.H.
        • Cutlip D.E.
        • Kappetein A.P.
        • Krucoff M.W.
        • Mack M.
        • Mehran R.
        • Miller C.
        • Morel M.A.
        • Petersen J.
        • Popma J.J.
        • Takkenberg J.J.
        • Vahanian A.
        • van Es G.A.
        • Vranckx P.
        • Webb J.G.
        • Windecker S.
        • Serruys P.W.
        Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium.
        Eur Heart J. 2011; 32: 205-217
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Pichard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        • Chamber Quantification Writing Group, American Society of Echocardiography's Guidelines and Standards Committee, European Association of Echocardiography
        Recommendation for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Bridges C.R.
        • Edwards F.H.
        • Peterson E.D.
        • Coombs L.P.
        • Ferguson T.B.
        Cardiac surgery in nonagenarians and centenarians.
        J Am Coll Surg. 2003; 197: 347-357
        • Brown J.M.
        • O'Brien S.M.
        • Wu C.
        • Sikora J.A.
        • Griffith B.P.
        • Gammie J.S.
        Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons national database.
        J Thorac Cardiovasc Surg. 2009; 137: 82-90
        • Guilfoyle M.R.
        • Drain A.J.
        • Khan A.
        • Ferguson J.
        • Large S.R.
        • Nashef S.A.
        Cardiac surgery in nonagenarians: single-centre series and review.
        Gerontology. 2010; 56: 378-384
        • Speziale G.
        • Nasso G.
        • Barattoni M.C.
        • Bonifazi R.
        • Esposito G.
        • Coppola R.
        • Popoff G.
        • Lamarra M.
        • Scorcin M.
        • Greco E.
        • Argano V.
        • Zussa C.
        • Cristell D.
        • Bartolomucci F.
        • Tavazzi L.
        Operative and middle-term results of cardiac surgery in nonagenarians: a bridge toward routine practice.
        Circulation. 2010; 121: 208-213
        • Moreno R.
        • Salazar A.
        • Bañuelos C.
        • Hernández R.
        • Alfonso F.
        • Sabaté M.
        • Escaned J.
        • Pérez M.J.
        • Azcona L.
        • Macaya C.
        Effectiveness of percutaneous coronary interventions in nonagenarians.
        Am J Cardiol. 2004; 94: 1058-1060
        • Lee M.S.
        • Zimmer R.
        • Pessegueiro A.
        • Jurewitz D.
        • Tobis J.
        Outcomes of nonagenarians who undergo percutaneous coronary intervention with drug-eluting stents.
        Catheter Cardiovasc Interv. 2008; 71: 526-530
        • Krane M.
        • Deutsch M.A.
        • Bleiziffer S.
        • Schneider L.
        • Ruge H.
        • Mazzitelli D.
        • Schreiber C.
        • Brockmann G.
        • Voss B.
        • Bauernschmitt R.
        • Lange R.
        Quality of life among patients undergoing transcatheter aortic valve implantation.
        Am Heart J. 2010; 160: 451-457
        • Gotzmann M.
        • Hehen T.
        • Germing A.
        • Lindstaedt M.
        • Yazar A.
        • Laczkovics A.
        • Mügge A.
        • Bojara W.
        Short-term effects of transcatheter aortic valve implantation on neurohormonal activation, quality of life and six-minute walk test in severe and symptomatic aortic stenosis.
        Heart. 2010; 96: 1083-1084