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Balloon-expandable TAVR feasible, offers clinical benefit for nonagenarians
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Older age alone should not preclude patients aged 90 years and older with severe aortic stenosis from undergoing balloon-expandable transcatheter aortic valve replacement, researchers reported in the American Journal of Cardiology.
For the new study, researchers evaluated 734 high-risk patients with severe aortic stenosis who underwent balloon-expandable TAVR at Cedars-Sinai Medical Center from April 2012 to December 2014. At the time of the procedure, 136 patients were aged 90 years or older (mean age, 92.4 years). The mean age of the other 598 patients was 78 years.
The researchers chronicled baseline clinical, echocardiographic and procedural data for all patients, including clinical and echocardiographic evaluations at 1-month follow-up. They compared the outcomes of the procedure in nonagenarians vs. those aged younger than 90 years at the time of the procedure.
At 30 days, all-cause mortality was 2.9% in patients aged 90 years and older vs. 2.8% in patients aged younger than 90 years (P = .95). At 1 year, the mortality rate was 12.5% among the nonagenarians vs. 12.3% among the younger patients (P = .75). With the exception of minor vascular complications, which were more common among nonagenarians (13.2% vs. 7.7%; P = .04), the researchers observed no difference in VARC–2-defined endpoints between the two age groups. A multivariate model revealed no significant link between nonagenarian status and all-cause mortality (HR = 0.93; 95% CI, 0.56-1.56).
In other results, patients aged 90 years or older had a significantly lower prevalence of CAD, chronic lung disease, diabetes and peripheral artery disease compared with those aged younger than 90 years. However, the older age group had higher rates of atrial fibrillation, chronic renal failure and frailty.
The researchers acknowledged that analysis of the mid- and long-term mortality effects of TAVR on nonagenarians is encumbered by their shorter life expectancies compared with younger patients. “Nevertheless, the mid-term survival of nonagenarians in the present study suggest that [TAVR] should not be precluded from appropriate candidates based solely on advanced age,” the researchers concluded. “Assessment of efficacy of [TAVR] in a very elderly population must take into account quality of life. [TAVR] improves both physical and mental quality of life in the geriatric population.” – by Jennifer Byrne
Disclosure: One researcher reports receiving grant support from Edwards Lifesciences Corporation and St. Jude Medical; consulting for Abbott Vascular, Cordis and Medtronic; and holding equity in Entourage Medical. Another researcher reports consulting for Edwards Lifesciences Corporation, St. Jude Medical and Venus MedTech. The other researchers report no relevant financial disclosures.
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