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TAVR advantageous for some very elderly patients
Transcatheter aortic valve replacement may be an acceptable alternative to surgical aortic valve replacement for the treatment of aortic stenosis in some very elderly patients, including those aged at least 85 years.
Researchers analyzed data from FRANCE-2, the French national TAVR registry. They studied 2,254 patients aged at least 80 years who were enrolled from January 2010 to October 2011. Patients were stratified by age: 80 to 84 years (n=867), 85 to 89 years (n=1,064) and 90 to 101 years (n=349). All had aortic stenosis but were ineligible for surgical AVR because of comorbidities. A self-expandable prosthesis (Corevalve, Medtronic) was implanted in 710 patients and a balloon-expandable prosthesis (Edwards Sapien or Sapien XT, Edwards Lifesciences) was implanted in 1,544 patients.
Use of the transfemoral TAVR approach increased with age (80-84 years, 72%; 85-89 years, 78.1%; 90-101 years, 82.1%; P<.001), whereas the use of the transapical approach (80-84 years, 20.5%; 85-89 years, 14.7%; 90-101 years, 11.6%; P<.001) and general anesthesia declined with age.
The procedural success rate in all three age groups was high, ranging from 97.8% among patients aged 80 to 84 years to 96.3% among patients aged 85 to 89 years. Length of hospital stay or time in the ICU did not differ between the groups.
There was no difference between the groups in cumulative 30-day mortality (80-84 years, 10.3%; 85-89 years, 9.5%; 90-101 years, 11.2%; P=.53). Cumulative 1-year mortality rates were higher in those aged at least 85 years compared with those aged 84 years and younger, but the trend was not significant (80-84 years, 19.8%; 85-89 years, 26.1%; 90-101 years, 27.7%; P=.16), the researchers wrote.
After adjustment for differential baseline characteristics and potential confounders, patient age was not associated with increasing risk for 30-day mortality (85-89 years vs. 80-84 years, HR=0.92; 95% CI, 0.66-1.27; 90-101 years vs. 80-84 years, HR=1.26; 95% CI, 0.83-1.94) or 1-year mortality (85-89 years vs. 80-84 years, HR=1.16; 95% CI, 0.9-1.49; 90-101 years vs. 80-84 years, HR=1.36; 95% CI, 0.97-1.89).
“Mortality rates in each age group were within acceptable limits considering the high-risk profile and age distribution of the patients in this study,” Masanori Yamamoto, MD, of Centre Hospitalier Universitaire (CHU)-Henri Mondor, Creteil, France, and colleagues wrote.
Independent predictors of 30-day mortality included high logistic EuroSCORE and NYHA class, whereas independent predictors of 1-year mortality included high logistic EuroSCORE, NYHA class, female sex, renal insufficiency and the transapical approach, according to the study findings.
Disclosure: The study was supported by Edwards Lifesciences and Medtronic. Several researchers report financial ties with Edwards Lifesciences and Medtronic.