Transcatheter aortic valve implantation in nonagenarians: Long-term cohort analysis from a pioneered center

Abstract

As the pioneer center in the transcatheter aortic valve implantation (TAVI) our experience provides the longest follow-up. The number of nonagenarians is rising dramatically. These patients often develop aortic stenosis. We aimed to assess the safety and long-term outcomes after TAVI in this population in our center from 2002 to 2016. All patients treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and yearly. Two groups were defined according to age: “< 90” and “ ≥ 90” . We compared population characteristics, 30-days outcomes and survival. A total of 1071 patients underwent TAVI during the period. One hundred and fifty-four were age “ ≥ 90” . Mean logistic EuroSCORE was lower in “ ≥ 90” (18.3 ± 11.8% vs. 20.8 ± 11.7%, P = 0.01). “ ≥ 90” had less diabetes mellitus (17.1 vs. 29.9%, P = 0.001), less peripheral arterial disease (10.4% vs. 16.6%, P = 0.05), less chronic obstructive pulmonary disease (8.5% vs. 20.1%, P = 0.001), and less severe pulmonary hypertension (4.5% vs. 12.2% vs. 4.5%, P = 0.01). “≥ 90” also had less prevalence of cancer (11.8% vs. 20.7%, P = 0.03), less coronary artery bypass surgery (0.6% vs.12.6%, P < 0.0001), and their renal function was better (creatinin: 103.0 ± 33.6 vs. 113.5 ± 65 μmol/L, P = 0.003). “ ≥ 90” were more treated by transfemoral approach (93.5% vs. 81%, P = 0.0001). Thirty-day mortality was not different (7.8% vs. 6.4%, P = 0.53). The incidence of 30-day major complications was similar. The incidence of aortic regurgitation above or equal to grade 2 (28.5% vs. 17.9%, P = 0.002) was more common in nonagenarians. Long-term survival was similar ( P = 0.26) ( Fig. 1 ). The life expectancy of these patients was comparable a population of the same age without aortic stenosis. Nonagenarians have less comorbidities. They benefit most from transfemoral approach. Outcomes are comparable to the overall population. TAVI is a safe and life-saving treatment in well-selected nonagenarian population.