Outcomes of nonagenarians after transcatheter aortic valve implantation
ABSTRACT Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline charac...
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oai:doaj.org-article:cf7b9677b3cc4a5a88af25dc1558bb202021-11-16T10:23:11ZOutcomes of nonagenarians after transcatheter aortic valve implantation10.24875/RECICE.M210002202604-7322https://doaj.org/article/cf7b9677b3cc4a5a88af25dc1558bb202021-11-01T00:00:00Zhttps://recintervcardiol.org/en/index.php?option=com_content&view=article&id=681https://doaj.org/toc/2604-7322ABSTRACT Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline characteristics of nonagenarians treated with TAVI and determine whether age ≥ 90 years is associated with a worse prognosis compared to non-nonagenarian patients. Methods: We included all patients ≥75 years enrolled in the multicenter prospective Spanish TAVI registry between 2009 and 2018. Patients < 75 years were excluded. Results: A total of 8073 elderly patients (≥ 75 years) from 46 Spanish centers were enrolled in the Spanish TAVI registry; 7686 were between ≥ 75 and < 90 years old (95.2%), and 387 were nonagenarian patients (4.79%). A gradual increase of nonagenarians was observed. The transfemoral access was used in 91.6% of the cases, predominantly among the nonagenarian patients (91.4% vs 95.1%, P = .01). Nonagenarians were more likely to die during their hospital stay (4.3% vs 7.0% among nonagenarians, P = .01). However, no difference was seen in the all-cause mortality rates reported at the 1-year follow-up (8.8% vs 11.3%, P =.07). In the multivariate analysis, age ≥ 90 years was not independently associated with a higher adjusted all-cause mortality rate (HR, 1.37, 95%CI, 0.91–1.97, P = .14). The baseline creatinine levels, and the in-hospital bleeding complications were all associated with a worse long-term prognosis in nonagenarians treated with TAVI. Conclusions: Nonagenarians are a very high-risk and growing population with severe AS in whom TAVI may be a safe and effective strategy. Careful patient selection by the TAVI heart team is mandatory to achieve maximum efficiency in this population where the baseline kidney function and bleeding complications may determine the long-term prognosis after TAVI.Pedro L. Cepas-GuillénAnder RegueiroDarío Sanmiguel CerveraRoberto Blanco MataJuan Francisco OteoIgnacio Amat-SantosFrancisco TenJuan Manuel NogalesEduard Fernández-NofreríasVicente MainarGarikoit Lasa-LarrayaLeire AndrakaJosé Antonio Baz-AlonsoMaría Cruz FerrerEduardo PinarRafael RomagueraCarlos Cuellas RamónFernando AlfonsoCristóbal A. Urbano-CarrilloSergio García-BlasAntonio PiñeroAgustín AlbarránRafael Ruiz-SalmerónJosé MoreuÓscar Gil AlbarovaJosé M. MeleroTomás Heredia CambraXavier FreixaManel SabatéPermanyerarticleTAVI Aortic stenosis Nonagenarians ElderlyMedicineRENESREC: Interventional Cardiology (English Ed.), Vol 3, Iss 4, Pp 250-257 (2021) |
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EN ES |
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TAVI Aortic stenosis Nonagenarians Elderly Medicine R |
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TAVI Aortic stenosis Nonagenarians Elderly Medicine R Pedro L. Cepas-Guillén Ander Regueiro Darío Sanmiguel Cervera Roberto Blanco Mata Juan Francisco Oteo Ignacio Amat-Santos Francisco Ten Juan Manuel Nogales Eduard Fernández-Nofrerías Vicente Mainar Garikoit Lasa-Larraya Leire Andraka José Antonio Baz-Alonso María Cruz Ferrer Eduardo Pinar Rafael Romaguera Carlos Cuellas Ramón Fernando Alfonso Cristóbal A. Urbano-Carrillo Sergio García-Blas Antonio Piñero Agustín Albarrán Rafael Ruiz-Salmerón José Moreu Óscar Gil Albarova José M. Melero Tomás Heredia Cambra Xavier Freixa Manel Sabaté Outcomes of nonagenarians after transcatheter aortic valve implantation |
| description |
ABSTRACT Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline characteristics of nonagenarians treated with TAVI and determine whether age ≥ 90 years is associated with a worse prognosis compared to non-nonagenarian patients. Methods: We included all patients ≥75 years enrolled in the multicenter prospective Spanish TAVI registry between 2009 and 2018. Patients < 75 years were excluded. Results: A total of 8073 elderly patients (≥ 75 years) from 46 Spanish centers were enrolled in the Spanish TAVI registry; 7686 were between ≥ 75 and < 90 years old (95.2%), and 387 were nonagenarian patients (4.79%). A gradual increase of nonagenarians was observed. The transfemoral access was used in 91.6% of the cases, predominantly among the nonagenarian patients (91.4% vs 95.1%, P = .01). Nonagenarians were more likely to die during their hospital stay (4.3% vs 7.0% among nonagenarians, P = .01). However, no difference was seen in the all-cause mortality rates reported at the 1-year follow-up (8.8% vs 11.3%, P =.07). In the multivariate analysis, age ≥ 90 years was not independently associated with a higher adjusted all-cause mortality rate (HR, 1.37, 95%CI, 0.91–1.97, P = .14). The baseline creatinine levels, and the in-hospital bleeding complications were all associated with a worse long-term prognosis in nonagenarians treated with TAVI. Conclusions: Nonagenarians are a very high-risk and growing population with severe AS in whom TAVI may be a safe and effective strategy. Careful patient selection by the TAVI heart team is mandatory to achieve maximum efficiency in this population where the baseline kidney function and bleeding complications may determine the long-term prognosis after TAVI. |
| format |
article |
| author |
Pedro L. Cepas-Guillén Ander Regueiro Darío Sanmiguel Cervera Roberto Blanco Mata Juan Francisco Oteo Ignacio Amat-Santos Francisco Ten Juan Manuel Nogales Eduard Fernández-Nofrerías Vicente Mainar Garikoit Lasa-Larraya Leire Andraka José Antonio Baz-Alonso María Cruz Ferrer Eduardo Pinar Rafael Romaguera Carlos Cuellas Ramón Fernando Alfonso Cristóbal A. Urbano-Carrillo Sergio García-Blas Antonio Piñero Agustín Albarrán Rafael Ruiz-Salmerón José Moreu Óscar Gil Albarova José M. Melero Tomás Heredia Cambra Xavier Freixa Manel Sabaté |
| author_facet |
Pedro L. Cepas-Guillén Ander Regueiro Darío Sanmiguel Cervera Roberto Blanco Mata Juan Francisco Oteo Ignacio Amat-Santos Francisco Ten Juan Manuel Nogales Eduard Fernández-Nofrerías Vicente Mainar Garikoit Lasa-Larraya Leire Andraka José Antonio Baz-Alonso María Cruz Ferrer Eduardo Pinar Rafael Romaguera Carlos Cuellas Ramón Fernando Alfonso Cristóbal A. Urbano-Carrillo Sergio García-Blas Antonio Piñero Agustín Albarrán Rafael Ruiz-Salmerón José Moreu Óscar Gil Albarova José M. Melero Tomás Heredia Cambra Xavier Freixa Manel Sabaté |
| author_sort |
Pedro L. Cepas-Guillén |
| title |
Outcomes of nonagenarians after transcatheter aortic valve implantation |
| title_short |
Outcomes of nonagenarians after transcatheter aortic valve implantation |
| title_full |
Outcomes of nonagenarians after transcatheter aortic valve implantation |
| title_fullStr |
Outcomes of nonagenarians after transcatheter aortic valve implantation |
| title_full_unstemmed |
Outcomes of nonagenarians after transcatheter aortic valve implantation |
| title_sort |
outcomes of nonagenarians after transcatheter aortic valve implantation |
| publisher |
Permanyer |
| publishDate |
2021 |
| url |
https://doaj.org/article/cf7b9677b3cc4a5a88af25dc1558bb20 |
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