Author + information
- Jeroen Vendrik1,
- Martijn van Mourik2,
- Floortje van Kesteren3,
- M. Marije Vis2,
- Karel Koch4 and
- Jan Baan2
The western population is aging and with this new health problems arise, one of them being (senile) aortic valve stenosis. Age is one of the independent factors in currently used risk scores to predict postoperative mortality after transcatheter aortic valve implantation (TAVI). This may not be completely justified for the highly selected population of nonagenarians.
To compare procedural outcome and mid-term mortality of the TF-TAVI patients ≥90 years to the other patients and assess the prognostic worth of age on these outcomes, we did a single center retrospective analysis of 599 consecutive TF-TAVI patients (2009-2017), divided in ≥90 and <90 years.
The nonagenarians are a highly selected subpopulation. They show more aortic regurgitation leading to less device success, more moderate to severe paravalvular leakage, more strokes and vascular complications and less bleeding complications. The predicted/actual procedural (30-day) mortality was 8.033/2.1 and 4.868/1.8 for respectively the nonagenarians and controls (p=0.536). Survival did not differ on the different time points (Logrank p=0.489, see KM-curve).
Procedural outcomes and mid-term survival is very acceptable in this highly selected subpopulation when compared to the ‘regular’ TF-TAVI patient. Age should not be an independent factor in predicting postoperative mortality, thus should not be a reason to deny very elderly patient TF-AVI treatment. The STS-PROM and EuroSCORE-II inadequately overestimate the postoperative mortality in this cohort, especially in the nonagenarians.
STRUCTURAL: Valvular Disease: Aortic