Management Of Valvular Heart Disease Research Articles

Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions.

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.

Same evidence different recommendations: a methodological assessment of transatlantic guidelines for the management of valvular heart disease.

To identify methodological variations leading to varied recommendations between the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) valvular heart disease (VHD) Guidelines, and to suggest foundational steps towards standardizing guideline development. An in-depth analysis was conducted to evaluate the methodologies used in developing the Transatlantic Guidelines for managing VHD. The evaluation was benchmarked against the standards proposed by the Institute of Medicine. Substantial discrepancies were noted in the methodologies utilized in development processes, including writing committee composition, evidence evaluation, conflict of interest management, and voting processes. Furthermore, despite their mutual differences, both methodologies also demonstrate notable deviations from the IOM standards in several essential areas, including literature review and evidence grading. These dual variances likely influenced divergent treatment recommendations. For example, the ESC/EACTS recommends transcatheter edge-to-edge repair (TEER) for patients ineligible for mitral valve surgery, while the ACC/AHA recommends TEER based on anatomy, regardless of surgical risk. ESC/EACTS guidelines recommend a mechanical aortic prosthesis for patients under 60, while ACC/AHA guidelines recommend it for patients under 50. Notably, the ACC/AHA and ESC/EACTS guidelines have differing age cut-offs for surgical over transcatheter aortic valve replacement (<65 and <75 years, respectively). Variations in methodologies for developing CPGs have resulted in different treatment recommendations that may significantly impact global practice patterns. Standardization of essential processes is vital to increase the uniformity and credibility of CPGs, ultimately improving healthcare quality, reducing variability and enhancing trust in modern medicine.

Unlocking the Secrets of Valvular Heart Disease: A Journey through the World of Imaging Modalities

Valvular heart disease is a prevalent and clinically significant condition with potential complications and adverse outcomes if left untreated or poorly managed. Accurate assessment of valve structure, function and hemodynamics is crucial for effective evaluation and management of valvular heart disease. In this systematic review, we provide a comprehensive overview and comparison of imaging modalities used in the assessment of valvular heart disease. The introduction highlights the background and significance of valvular heart disease, emphasizing its impact on cardiovascular health, global prevalence, and associated complications. Furthermore, it emphasizes the importance of imaging modalities in the evaluation and management of valvular heart disease, discussing their role in providing crucial information for accurate diagnosis, risk stratification, treatment planning, and monitoring. The objective of this review article is to summarize the strengths, limitations and diagnostic accuracy of different imaging modalities in valvular heart disease assessment. We present detailed discussions on echocardiography, computed tomography (CT) imaging, nuclear imaging techniques and emerging imaging modalities, such as 3D echocardiography, strain imaging and fusion imaging. Each section explores the specific role of the imaging modality, its advantages, limitations and diagnostic accuracy in the evaluation of valvular heart disease. Additionally, we provide a comparative analysis of these imaging modalities, highlighting their strengths, weaknesses and specific indications. The integration of multiple imaging modalities for a comprehensive evaluation in specific scenarios is also discussed, emphasizing the complementary roles of different modalities in optimizing diagnostic accuracy and treatment planning. The review concludes with implications for clinical practice and future research directions. It underscores the importance of selecting the appropriate imaging modality or combination of modalities based on individual patient characteristics and clinical needs. Furthermore, it highlights the potential clinical impact of emerging imaging techniques and the need for standardization, cost-effectiveness studies, and further research to optimize the utilization of imaging modalities in valvular heart disease management. Bangladesh Heart Journal 2023; 39(1): 49–56

Potential Role of NT-proBNP and Tissue Doppler Indices to Assess the Severity of Rheumatic Heart Disease: A Cross-sectional Study

Introduction: Rheumatic Heart Disease (RHD) remains the primary cause of acquired Valvular Heart Disease (VHD) in developing countries. The role of Tissue Doppler Indices (TDI) in RHD is understudied. This study aims to fill evidence gaps identified by the American College of Cardiology/American Heart Association in the management of Valvular Heart Disease (VHD) by analysing newer echocardiographic techniques {Tissue Doppler Imaging (TDI)} and biochemical markers (NT-proBNP) against clinical parameters {New York Heart Association (NYHA)} in an understudied patient group. Aim: To evaluate the role of TDI and its association with the functional class of dyspnoea and serum NT-proBNP levels in RHD. Materials and Methods: This cross-sectional study was conducted in the Cardiology and Medicine departments, Central Gujarat, Western India, from January 2021 to June 2022. Fifty-seven consenting adult patients with RHD who underwent echocardiography with Standard Echocardiographic Techniques (SET) to stratify VHD severity were included. Patients were divided into three sub-groups: a) Isolated MR and MR with mild/moderate MS (n=23); b) Isolated MS and MS with mild MR (n=29); and c) Isolated MS and MS with mild or moderate MR (n=48). TDI parameters (e’, a’, e’/a’, and E/e’) at medial mitral, lateral mitral, and tricuspid annuli, NYHA classification, and serum NT-proBNP levels were analysed. The Analysis of Variance (ANOVA) was used to assess the association between NYHA class and clinical and NT-proBNP parameters. The Pearson correlation coefficient was employed to determine linear relationships between NT-proBNP and TDI parameters. Results: The mean age was 45.4±16 years, with the age groups 20-40 years (n=20) and 40-60 years (n=22) having a nearly equal distribution. The female-to-male ratio was 1.48 (34/23). In subgroup C, the a’ velocity decreased from 13.74±3.92 cm/s in NYHA I to 5.17±1.98 cm/s in NYHA IV (p=0.0312), and the e’/a’ ratio increased from 0.96±0.40 in NYHA I to 2.41±1.00 in NYHA IV (p=0.0210). These changes paralleled trends in a’ value (p=0.0306) and e’/a’ ratio (p=0.0157) with increasing NTproBNP levels. Conclusion: At the tricuspid annulus, the e’/a’ ratio and a’ velocity can complement NT-proBNP in cases where there is a discrepancy between the clinical status of the patient and the severity of the valve lesion as determined by SET. Larger-scale studies are needed to further evaluate the association between TDI parameters and long-term clinical outcomes, as well as to identify the optimal timing for surgical intervention in RHD patients.

Navigating the Unexpected: Iatrogenic Aortic Injuries during Transcatheter Aortic Valve Replacement (TAVR).

The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative to surgical aortic valve replacement. However, it is important to consider the potential risks associated with TAVR and ways in which life-threatening complications can be identified and managed in a timely fashion. In this article, we review some catastrophic iatrogenic aortic injuries that are described in the literature and present a case of an acute iatrogenic type A aortic dissection that occurred during a transcatheter aortic valve replacement (TAVR). After valve deployment, a routine neurologic examination noted the new onset of a left-sided facial droop and upper extremity weakness. Urgent imaging revealed an extensive type A aortic dissection, and the patient was taken to the operating room for surgical repair. The coordination of our multidisciplinary team allowed for prompt recognition of her neurologic symptoms, urgent imaging, and timely transport to the operating room, all of which contributed to the successful management of this life-threatening procedural complication.

Higher Edmonton Frail Scale prior to transcatheter Aortic Valve Implantation is related to longer hospital stay and mortality

BackgroundInternational guidelines for the management of valvular heart disease recommend frailty assessment prior to Transcatheter Aortic Valve Implantation (TAVI), however there is no consensus how to assess frailty. We investigated whether frailty status assessed with the Edmonton Frail Scale (EFS, range 0–17 points) relates to length of stay (LOS), short- and long-term mortality and adverse outcomes after TAVI. MethodsIn this study we included 357 patients between April 2016 till December 2018. EFS was assessed at baseline. Patients were classified into low (0–3), intermediate (4–7) or high frailty status (8‐17). LOS was defined as the number of days between admission and discharge. Mortality data were obtained up to four years after TAVI. Adverse events were defined by Valve Academic Research Consortium (VARC)-2 criteria and collected <30 days after TAVI. ResultsPatients with higher frailty status had longer median LOS (days (IQR): low 5 (3), intermediate 6 (4) and high 7 (5), p < 0.001) and higher mortality: low vs intermediate vs high at 30 days 0.5%, 2.2%, 7.0% (p = 0.050), 1 year 3.7%, 10.0%, 15.2% (p = 0.052), 2 years 9.2%, 17.8%, 31.7% (p = 0.003), 3 years 17.2%, 24.0, 47.0% (p = 0.001) and 4 years 19.6%, 30.8%, 55.6% (p < 0.001). Frail patients received more often a pacemaker (2.6%, 6.6%, 13.5%, p = 0.048). ConclusionIn clinical practice, the EFS is a useful tool to screen for frailty in TAVI patients. This tool may possibly be expanded to determine benefit versus harm-risk in these patients and whether specific pre-procedurally interventions are needed in order to reduce mortality.

Mechanical heart valves and oral anticoagulation: a survey of the Italian Society of Cardiac Surgery.

In the latest European guidelines for the management of valvular heart disease, mechanical valve prostheses maintain a strategic role, particularly for certain patient subsets and age groups. Despite the high number of devices implanted in clinical practice, particularly in non-European and North American regions, current scientific literature and debate seem to suggest a limited use of mechanical heart valves. The cardiac surgery community seems to be highly interested in biological and transcatheter valve prostheses but less interested in mechanical heart valves, including possible strategies for self-management of anticoagulation therapy. In this respect, the Italian Society of Cardiac Surgery (SICCH), in particular the Italian Group of Research for Outcome in Cardiac Surgery (GIROC), has promoted a survey among its members to stimulate the interest in this topic and express their opinion on this issue that, due to the prevalence of the affected population and the new treatment options for improving patients' quality of life, should be more appraised and debated in the cardiac surgery community. The recorded results, obtained on the answers to 111 questionnaires, seem to divide the specialists into 'pros' and 'contras' on a useful tool for the entire cardiac surgery community. For this reason, SICCH proposes in conclusion to declare its unified and institutional opinion on this topic.

Prognostic role of extracardiac incidentalomas detected with computed tomography in patients with severe aortic stenosis candidates for transcatheter aortic valve replacement

Abstract Background Aortic stenosis is one of the most common valvular heart diseases worldwide, especially among older individuals. According to the latest guidelines for the management of valvular heart disease, in patient with high surgical risk and aged 75 years and older, transcatheter aortic valve replacement (TAVR) is the first therapeutic option to be considered (1). Every patient undergoing TAVR should perform a computed tomography (CT) scan before percutaneous procedure. An incidentaloma is defined as an unexpected finding on a CT scan performed for another clinical reason. Purpose The purpose of this study is to determine the prognostic role of incidentalomas found on CT scan performed pre-TAVR procedure in elderly patients with severe aortic stenosis. Methods We performed a monocentric retrospective observational study of 284 patients with severe aortic stenosis evaluated for TAVR from January 2016 to December 2022. All data were collected retrospectively and processed anonymously. Patients' clinical data (past medical history, cardiovascular risk factors, comorbidities, echocardiogram and coronary artery angiography findings) were collected, and all CT scans were reviewed for the presence of incidentalomas. An incidentaloma was considered clinically relevant only if further investigations were required following its diagnosis. Statistical analyses were performed using Mann-Whitney test, uni- and multivariate Cox regression models. Only variables with p&amp;lt;0,05 on univariate analysis were included in multivariate models. The primary endpoint of the study was delay in TAVR implantation. The secondary endpoint was death. Results We analyzed 284 patients’ data with a median age of 87 (83-90) years. The median follow-up was 713 (464-1130) days in which 165 (58%) patients underwent TAVR and 83 (29%) deceased. Among the patients, 43 incidentalomas were diagnosed (Table 1). About primary endpoint, within patients who underwent TAVR, median delay to the procedure was 217 (160-284) days and there was not statically difference in delay between patients with or without incidentalomas (Mann-Whitney test p=0,08) (Figure 1). Furthermore, about the secondary endpoint, incidentalomas were not associated with death on univariate analysis (p=0,38) (Figure 2). Atrial fibrillation, chronic kidney disease (CKD), dilatation of left ventricle, left ventricular ejection fraction (LVEF) and TAVR were statistically significant among patients survived or not. LVEF was not associated with outcome (p=0,06) on univariate Cox regression analysis. In multivariate model (Table 2) TAVR reduced risk of death, instead CKD and dilated left ventricle increased risk. Conclusion Between patients with severe aortic stenosis candidates for TAVR presence of clinically relevant incidentalomas on CT scan was not associated with significant delay in procedure or death. Further studies are needed to prospectively confirm these results on a larger cohort of patients.Table 1 and Table 2Figure 1 and Figure 2

The association of CT-assessed fat-free muscle fraction with frailty and malnutrition and the predictive value of their combination in patients undergoing TAVR

Abstract Background Frailty is a multidimensional syndrome that affects mortality after TAVR. Malnutrition is a related condition and promotes the development of frailty. The current guidelines for the management of valvular heart disease recommend an objective evaluation of frailty for risk stratification in patients with aortic stenosis. However, the proposed frailty scales are time-consuming and provide inconsistent results, due to their semiquantitative nature. Computed tomography (CT) is a part of routine pre-interventional TAVR workup and allows for additional body composition analysis, including the assessment of fat-free muscle fraction (FFMF) as an indicator of muscle quality. Aims The aim of this study was to evaluate the relationship between FFMF and frailty as well as malnutrition, as assessed with various scales and to examine the predictive value of FFMF and frailty in patients with AS undergoing TAVR. Methods Our study cohort consisted of 206 patients undergoing TAVR between 2018 and 2019. Frailty was assessed using the Fried Frailty Phenotype (FFP) and the Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF). Furthermore, the patients were evaluated with CT scans, and skeletal muscle area at the L3/L4 level was determined. The skeletal muscle area was separated in areas of fatty and lean muscle according to densitometric thresholds to calculate the FFMF (Figure 1). Outcome of interest was one-year mortality following TAVR. Results The prevalence of frailty ranged from 46.1% (n=95), as assessed with the FFP score to 7.3% (n=15), as classified using the Katz Index. Nutritional assessment using the MNA-LF scale showed that 107 (51.9%) patients were at normal nutritional status, whereas 85 (41.3%) patients were at risk for malnutrition, and 14 (6.8%) patients were already malnourished. According to the CT evaluation 64 (31.1%) patients had a high FFMF, 73 (35.4%) patients had a medium FFMF, and 69 (33.5%) patients had a low FFMF. A Low FFMF was associated with higher rates of frailty and malnutrition according to all scales tested (Figure 2 A). However, depending on various scales, the prevalence of frailty and malnutrition showed a wide range among patients with a low FFMF, reaching from 10.8% as assessed with the MNA-LF to 66.0% as evaluated by the FFP scale. A low FFMF was associated with increased one-year mortality (20.3%) as compared to a medium (6.8%) or low FFMF (6.3%, p=0.01, Figure 2 B). Moreover, a combination of FFMF with frailty was superior to frailty alone in predicting patient's outcome following TAVR. Conclusion The CT-assessed FFMF is a strong and independent predictor of dismal outcomes in patients undergoing TAVR. A low FFMF is associated with significantly higher rates of frailty and malnutrition. Moreover, a combination of FFMF with frailty scales may better identify vulnerable patients at risk of an unfavorable outcome after TAVR.Figure 1Figure 2 A - B

Invasive Functional Assessment of Coronary Artery Disease in Patients with Severe Aortic Stenosis in the TAVI Era.

Coronary artery disease (CAD) is a common finding in patients suffering from aortic valve stenosis (AS), with a prevalence of over 50% in patients 70 years of age or older. Transcatheter aortic valve intervention (TAVI) is the standard treatment option for patients with severe AS and at least 75 years of age. Current guidelines recommend percutaneous coronary intervention (PCI) in patients planned for TAVI with stenoses of >70% in the proximal segments of non-left main coronary arteries and in >50% of left main stenoses. While the guidelines on myocardial revascularization clearly recommend functional assessment of coronary artery stenoses of less than 90% in the absence of non-invasive ischemia testing, a statement regarding invasive functional testing in AS patients with concomitant CAD is lacking in the recently published guideline on the management of valvular heart disease. This review aims to provide an overview of the hemodynamic background in AS patients, discusses and summarizes the current evidence of invasive functional testing in patients with severe AS, and gives a future perspective on the ongoing trials on that topic.

Whats new in ESC Guidelines for the management of valvular heart disease?

The article summarize the most important changes regarding the management of valvular heart disease, which have been made in the ESC Guidelines 2021. Based on the randomized clinical study data, which were recently published, the most frequent changes were done in terms of the choice of mode of intervention in the aortic and mitral valves as well as in the management of the antithrombotic therapy.

2022 CMICS Expert Consensus on the Management of Isolated Tricuspid Regurgitation after Left-Sided Valve Surgery

Tricuspid regurgitation (TR) may occur late after left-sided valve surgery (LSVS). Isolated tricuspid regurgitation after left-sided valve surgery (iTR-LSVS) refers to isolated TR without significant lesions in the mitral and/or aortic position late after mitral and/or aortic replacement or repair. Severe TR has a negative impact on long-term prognosis and requires surgical or transcatheter treatment. However, there is no clear recommendation on when and how intervention should be performed for patients with iTR-LSVS in the current guidelines for the management of valvular heart disease. The historically high operative mortality may be reduced by current minimally invasive techniques and transcatheter therapy. To further understand iTR-LSVS, standardize the treatment, improve the prognosis, and promote the collaboration, the Chinese Minimally Invasive Cardiovascular Surgery Committee (CMICS) wrote this expert consensus on the management of iTR-LSVS from the aspects of etiology, preoperative evaluation, indications for intervention, surgical treatment, transcatheter therapy, and postoperative management.

Unmet needs in valvular heart disease.

Valvular heart disease (VHD) is the next epidemic in the cardiovascular field, affecting millions of people worldwide and having a major impact on health care systems. With aging of the population, the incidence and prevalence of VHD will continue to increase. However, VHD has not received the attention it deserves from both the public and policymakers. Despite important advances in the pathophysiology, natural history, management, and treatment of VHD including the development of transcatheter therapies, VHD remains underdiagnosed, identified late, and often undertreated with inequality in access to care and treatment options, and there is no medication that can prevent disease progression. The present review article discusses these gaps in the management of VHD and potential actions to undertake to improve the outcome of patients with VHD.

Transcatheter valvular therapies in patients with left ventricular assist devices.

Aortic, mitral and tricuspid valve regurgitation are commonly encountered in patients with continuous-flow left ventricular assist devices (CF-LVADs). These valvular heart conditions either develop prior to CF-LVAD implantation or are induced by the pump itself. They can all have significant detrimental effects on patients' survival and quality of life. With the improved durability of CF-LVADs and the overall rise in their volume of implants, an increasing number of patients will likely require a valvular heart intervention at some point during CF-LVAD therapy. However, these patients are often considered poor reoperative candidates. In this context, percutaneous approaches have emerged as an attractive "off-label" option for this patient population. Recent data show promising results, with high device success rates and rapid symptomatic improvements. However, the occurrence of distinct complications such as device migration, valve thrombosis or hemolysis remain of concern. In this review, we will present the pathophysiology of valvular heart disease in the setting of CF-LVAD support to help us understand the underlying rationale of these potential complications. We will then outline the current recommendations for the management of valvular heart disease in patients with CF-LVAD and discuss their limitations. Lastly, we will summarize the evidence related to transcatheter heart valve interventions in this patient population.

Transcatheter Valve Implantation in Patients with Multivalvular Heart Disease

Transcatheter Valve Implantation in Patients with Multivalvular Heart Disease

Management of valvular heart disease in patients withcancer: Multidisciplinary team, cancer-therapy related cardiotoxicity, diagnosis, transcatheter intervention, andcardiac surgery. Expert opinion of the Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and Working Group on Cardiac Surgery of the Polish Cardiac Society.

The Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and the Working Group on CardiacSurgery of the Polish Cardiac Society have released a position statement on risk factors, diagnosis, and management of patients with cancer and valvular heart disease (VHD). VHD can occur in patients with cancer in several ways, for example, it can exist or be diagnosed before cancer treatment, after cancer treatment, be an incidental finding during imaging tests, endocarditis related to immunosuppression, prolonged intravenous catheter use, or combination treatment, and nonbacterial thrombotic endocarditis. It is recommended to employ close cardiac surveillance for patients at high risk of complications during and after cancer treatment and for cancer treatments that may be cardiotoxic to be discussed by a multidisciplinary team. Patients with cancer and pre-existing severe VHD should be managed according to the 2021 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines for VHD management, taking into consideration cancer prognosis and patient preferences.

Comparison of the Recent Updates to the ACC/AHA and ESC Guidelines for the Management of Valvular Heart Disease: Similarities and Differences.

There have been several advances in the diagnosis and management of valvular heart disease (VHD) over the last decade. These have been reflected in the latest European and North American guidelines, although both contain significant similarities and differences. In this review, we highlight the important overlaps and variations between the updated guidelines and their previous versions to help guide the general cardiologist. There has been extensive revision on the use of percutaneous treatments, the indications for intervention in asymptomatic VHD, and perioperative bridging therapies. The updated guidelines provide new recommendations in many aspects of VHD; however, there remain significant gaps in the role of biomarkers in VHD and the long-term outcomes of novel oral anticoagulants (NOACs) and transcatheter therapies.

The Oral Microbiota in Valvular Heart Disease: Current Knowledge and Future Directions.

Oral microbiota formation begins from birth, and everything from genetic components to the environment, alongside the host's behavior (such as diet, smoking, oral hygiene, and even physical activity), contributes to oral microbiota structure. Even though recent studies have focused on the gut microbiota's role in systemic diseases, the oral microbiome represents the second largest community of microorganisms, making it a new promising therapeutic target. Periodontitis and dental caries are considered the two main consequences of oral bacterial imbalance. Studies have shown that oral dysbiosis effects are not limited locally. Due to technological advancement, research identified oral bacterial species in heart valves. This evidence links oral dysbiosis with the development of valvular heart disease (VHD). This review focuses on describing the mechanism behind prolonged local inflammation and dysbiosis, that can induce bacteriemia by direct or immune-mediated mechanisms and finally VHD. Additionally, we highlight emerging therapies based on controlling oral dysbiosis, periodontal disease, and inflammation with immunological and systemic effects, that exert beneficial effects in VHD management.

Artificial Intelligence-assisted Medical Imaging in Interventional Management of Valvular Heart Disease

Artificial Intelligence-assisted Medical Imaging in Interventional Management of Valvular Heart Disease

Long-term survival and outcomes according to age for patients underwent to transcatheter aortic valve replacement

Abstract Background Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The 2021 ESC/EACTS guidelines for the management of valvular heart disease recommended TAVR in older patients ≥75 years or in those who are high risk. The aim of this study was to determine the survival and the factors predicting mortality after TAVR in according to age. Methods From April 2008 to December 2020, a total of 991 patients with symptomatic severe aortic stenosis underwent TAVR with balloon-expandable or self-expanding valves were included. Primary outcomes and survival analysed on base to age &amp;lt;75 years and ≥75 years old. Results The mean age in patients &amp;lt;75 compared with ≥75 years, was 68.2±7.5 vs. 81.4±3.8 years and STS score were 4.24±3.1% vs. 5.4±3.1%. In-hospital mortality was 3.8% vs. 3.1%, (OR= 0.825, 95% confidence interval [CI] 0.034–2.037, p=0.676, and the combined endpoint of death, vascular complications, myocardial infarction, major bleeding or stroke was 13.4% vs. 17.8%, OR = 1.39 95% CI 0.842–2.309) p=0.195, respectively. When compared both groups (75 compared with ≥75 years) in the follow-up, there were no differences in tbleeding 5.7% vs. 3.8% (HR = 0.584 [IC95% 0.278–21.226], p=0.155), myocardial infarction 5% vs. 2.1% (HR = 0.447 [IC95% 0.209–1,090], p=0.08), stroke 5.7% vs. 9.9% (HR = 1.617 [IC95% 0.812–3.219], p=0.171) and mortality 47.2% vs. 44.8% (HR=0.862 [IC95% 0.672–1.105], p=0.241) and there was difference in between groups by hospitalizations for heart failure 16.4% vs. 10.3% (HR = 0.583 [IC95% 0.373–0.912], p=0.018 Survival at 1, 3, 5, and 8 years were similar in both groups (75 compared with ≥75 years): 74.8% vs. 83.4%, 61.1 vs. 69.6%, 45 vs. 51.1% and 35% vs. 31.8% log Rank 1.551, p=0.213, respectively, after a mean follow-up of 44.8±31 months. The predictors of cumulative mortality were in patients &amp;lt;75 years: Charlson index (HR 1.283 [95% CI 1.037–1.587], p=0.022) and STS score (HR 1.224 [95% CI 1.095–1.368], p=0.001) and the predictors in patients with ≥75 years in addition to Charlson index and STS score, were: Stroke postTAVR (HR 2.692 [95% CI 1.380–5.228], p=0.003), Frailty (HR 1.634 [95% CI 1.159–2.034], p=0.005), reduced left ventricular ejection fraction (HR 0.407 [95% CI 0.191–01.867], p=0,020], COPD (HR 1.472 [95% CI 1.043–2.077], p=0,003], mitral regurgitation post-TAVR (HR 1.190 [1.006–1.409], p=0.043. Conclusions TAVR is associated with significant survival benefit throughout 3.29 years of follow-up in both groups. Survival during follow-up was similar in patients with &amp;lt;75 compared with ≥75 years old, but they present some differences in the predictors of mortality, with a greater impact of complications post-TAVR in the elderly. Funding Acknowledgement Type of funding sources: None.