Outcomes of transcatheter aortic valve implantation in nonagenarians compared to < 90 years patients

Abstract

Given that life expectancy has been improved, nonagenarians become a significant proportion of world population. As aortic stenosis is primarily a disease of the elderly, the need for invasive cardiac approaches is expected to increase in people of extreme age We compare the in-hospital adverse clinical outcomes and mortality after TAVI procedures in nonagenarians to < 90 years patients. A retrospective study was conducted on 1336 patients who underwent TAVI at Toulouse University hospital, Rangueil, France. Post-TAVI adverse clinical outcomes were defined according to Valve Academic Research Consortium-2 Criteria. The studied population was divided into 2 groups according to age. Out of 1336 patients, 250 (18.7%) were nonagenarians with a mean age of 91.8 ± 1.9 years.While comorbidities were less common in nonagenarians, the calculated scores to predict mortality were significantly higher. Pacemaker implantation (12.4% vs. 12.1%, P = 0.08), stroke (2% vs. 1.8%, P = 0.86) and major vascular complications (9.2% vs. 6.7%, P = 0.17) were more common in nonagenarians while acute kidney injury (1.2% vs. 2.7%, P = 0.15) and major bleeding events (3.2%vs3.4%, P = 0.87) were more common in < 90 year group. The rate of procedures success in nonagenarians and < 90 year group was 93.2% and 96.9%, respectively. Adjusted multivariate analysis showed that Nonagenarians are more likely to develop major vascular complications [OR = 1.76 95%CI (1.04;3)]. Survival analysis showed a significant difference in mortality during hospitalization period only ( P = 0.004) The prevalence of TAVI success is remarkably high in nonagenarians and comparable to that of younger age. The nonagenarians are significantly at higher risk for in-hospital death after TAVI and they are more likely to develop major vascular complications. The difference in mortality rate during hospitalization period was two times more but it becomes no longer significant after hospital discharge.