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Juarez-Casso FM, Singh M, Lewis BR, Sandhu GS, Arghami A, Rowse PG, Bagameri G, Crestanello JA, Greason KL. Long-term Stroke and Mortality Risk in Nonagenarians After Transcatheter Aortic Valve Insertion. Ann Thorac Surg 2024:S0003-4975(24)00372-2. [PMID: 38763221 DOI: 10.1016/j.athoracsur.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Limited data exist on the long-term outcomes of transcatheter aortic valve insertion (TAVI) in nonagenarian patients. This study investigated the relationship between patient baseline comorbidity and frailty on the long-term outcome of the nonagenarian population. METHODS A retrospective analysis was conducted of 187 consecutive nonagenarian patients who underwent TAVI from 2009 to 2020. Multivariable models were used to analyze the association between baseline patient and frailty variables and mortality, stroke, and repeat hospitalization. Long-term survival was compared with an age- and sex-matched United States population. RESULTS The median Society of Thoracic Surgeons predicted risk of mortality was 10% (interquartile range, 7%-17%). Frailty was met in 72% of patients based on the 5-meter walk test, 13% based on the Kansas City Cardiomyopathy Questionnaire 12-item instrument score, 12% based on Katz Index of Independence in Activities of Daily Living, and 8% based on serum albumin levels. Procedure-related death occurred in 3 patients (2%) and stroke in 8 (4%). The median duration of follow-up was 3.4 years. Outcomes included death in 150 patients (80%), stroke in 15, and repeat hospitalization in 114. Multivariable analysis identified no association between any of the baseline patient variables with mortality, stroke, repeat hospitalization, or the combined outcomes (all P > .05). The 1- and 5-year survival rates in TAVI-treated nonagenarians were similar to age- and sex-matched controls (P = .27). CONCLUSIONS Long-term death or stroke is independent of The Society of Thoracic Surgeons predicted risk of mortality and frailty risk variables in this nonagenarian patient population who received TAVI. Furthermore, survival is similar to age- and sex-matched controls.
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Affiliation(s)
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Lewis
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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Nistri S, Mele D, Tarantini G. Pioneering Long-Term Outcome of Transcatheter Aortic Valve Replacement in Nonagenarians: A Scientific Odyssey. Am J Cardiol 2024; 215:85-86. [PMID: 38224728 DOI: 10.1016/j.amjcard.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Stefano Nistri
- Department of Cardiac, Thoracic and Vascular Science, Padua University, Padua, Italy; Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina (VI), Italy.
| | - Donato Mele
- Department of Cardiac, Thoracic and Vascular Science, Padua University, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Padua University, Padua, Italy
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Benenati S, Gallo F, Kim WK, Khokhar AA, Zeus T, Toggweiler S, Galea R, De Marco F, Mangieri A, Regazzoli D, Reimers B, Nombela-Franco L, Barbanti M, Regueiro A, Piva T, Rodes-Cabau J, Porto I, Colombo A, Giannini F, Sticchi A. Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff. J Cardiovasc Dev Dis 2024; 11:33. [PMID: 38276659 PMCID: PMC10816002 DOI: 10.3390/jcdd11010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. METHODS Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality. RESULTS A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank p = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99-1.04, p = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51, p = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes). CONCLUSIONS TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.
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Affiliation(s)
- Stefano Benenati
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, Italy (I.P.)
| | - Francesco Gallo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell’Angelo, AULSS3 Serenissima, Mestre, 30174 Venezia, Italy
| | - Won-keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
| | - Arif A. Khokhar
- Cardiology Service, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, 40225 Duesseldorf, Germany
| | - Stefan Toggweiler
- Department of Cardiology, Cantonal Hospital Lucern, 6000 Luzern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | | | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luis Nombela-Franco
- Interventional Cardiology Unit, Hospital Àlvaro Cunqueiro, 36312 Vigo, Spain
| | - Marco Barbanti
- Faculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, 60126 Ancona, Italy;
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
| | - Italo Porto
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, Italy (I.P.)
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy
| | - Alessandro Sticchi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
- Dipartimento di Patologia Chirurgica, University of Pisa, Medica, Molecolare e dell’Area Critica, 56126 Pisa, Italy
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Bernard J, St-Louis R, Robichaud M, Kalavrouziotis D, Dumont É, Paradis JM, Babaki S, Rodés-Cabau J, Mohammadi S. Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age? CJC Open 2023; 5:784-791. [PMID: 37876887 PMCID: PMC10591129 DOI: 10.1016/j.cjco.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/03/2023] [Indexed: 10/26/2023] Open
Abstract
Background Clinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years. Methods We conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires. Results During the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], P < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all P < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%. Conclusions Nonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.
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Affiliation(s)
- Jérémy Bernard
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Roxanne St-Louis
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Mathieu Robichaud
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Éric Dumont
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Shervin Babaki
- Division of Research, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
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Rudolph T, Appleby C, Delgado V, Eltchaninoff H, Gebhard C, Hengstenberg C, Wojakowski W, Petersen N, Kurucova J, Bramlage P, Bleiziffer S. Patterns of Aortic Valve Replacement in Europe: Adoption by Age. Cardiology 2023; 148:547-555. [PMID: 37586346 DOI: 10.1159/000533633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION The management of patients with severe aortic stenosis may differ according to patients' age. The aim of this analysis was to describe patterns of aortic valve replacement (AVR) use in European countries stratified by age. METHODS Procedure volume data for AVR, including surgical aortic valve replacement (sAVR) and transcatheter aortic valve implantation (TAVI), for the years 2015-2020 were obtained from national databases for twelve European countries (Austria, the Czech Republic, Denmark, England, Finland, France, Germany, Norway, Poland, Spain, Sweden, and Switzerland). Procedure volumes were reported by patient age (<50 years, 5-year age groups between 50 and 85 years, and ≥85 years). Patients per million (PPM) population undergoing AVR each year were calculated using population estimates from Eurostat. RESULTS AVR PPM varied widely between countries, from 508 PPM in Germany to 174 PPM in Poland in 2020. TAVI rates ranged from 61% in Switzerland and Finland to 25% in Poland. AVR PPM increased with age to a peak at 80-84 years, after which it decreased again. AVR procedures increased from 2015 to 2019 at an average annual rate of 3.9%. AVR increased more substantially in people aged ≥80 years than in younger age groups; these older age groups accounted for 30% of all AVR procedures in 2015 and 35% in 2019. TAVI accounted for an increasing proportion of all AVR procedures as patient age increased; an overall average of 96% of males and 98% of females aged ≥85 years received TAVI as the treatment modality, although adoption of TAVI differed between countries. CONCLUSIONS There is considerable variation in the rates of AVR use and the adoption of TAVI versus sAVR between European countries. The use of TAVI has increased in recent years, particularly for older patients.
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Affiliation(s)
- Tanja Rudolph
- General and Interventional Cardiology/Angiology, Heart and Diabetes Centre Nord Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Clare Appleby
- Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Victoria Delgado
- Heart Institute, Department of Cardiology, Hospital University Germans Trias I Pujol Barcelona, Badalona, Spain
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Catherine Gebhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Hengstenberg
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Jana Kurucova
- Medical Affairs, Edwards Lifesciences, Prague, Czechia
| | - Peter Bramlage
- Institute for Pharmacology und Preventive Medicine, Cloppenburg, Germany,
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
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6
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Fukutomi M, Onishi T, Ando T, Higuchi R, Hagiya K, Saji M, Takamisawa I, Iguchi N, Takayama M, Shimizu A, Shimizu J, Doi S, Okazaki S, Sato K, Tamura H, Yokoyama H, Takanashi S, Tobaru T. Impact of periprocedural bleeding on mid-term outcome in nonagenarians who underwent transcatheter aortic valve implantation: insights from LAPLACE registry. J Thromb Thrombolysis 2023:10.1007/s11239-023-02800-2. [PMID: 37061662 DOI: 10.1007/s11239-023-02800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/17/2023]
Abstract
Data from several recent studies have demonstrated the safety and efficacy of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) even in nonagenarians. However, the impact of periprocedural bleeding following TAVI on their outcome remains unclear. In the aLliAnce for exPloring cLinical prospects of AortiC valvE disease (LAPLACE) registry, we compared outcomes between the bleeding and no-bleeding groups among 1953 patients < 90 years old (mean age, 83.0 ± 4.6 years old) and 316 nonagenarians (mean age, 91.7 ± 1.9 years old) who underwent TAVI with a median follow-up period of 628 days. The group with any periprocedural bleeding showed a higher 30-day mortality than the no-bleeding group in patients < 90 years old (3.3% vs. 0.5%, p = 0.001) and nonagenarians (7.9% vs. 0.7%, p = 0.001). In patients < 90 years old, severe periprocedural bleeding (n = 85) was associated with a higher mid-term all-cause mortality rate than no severe bleeding (n = 1,868), even after adjusting for covariates (hazard ratio [HR], 1.994; 95% confidence interval [CI] 1.287-2.937; p = 0.002). On the other hand, in nonagenarians, any periprocedural bleeding (n = 38) was associated with a higher mid-term cardiovascular (CV) mortality rate (21.1% vs. 4.3%, log-rank p = 0.014) than no bleeding (n = 278), even after adjusting for covariates (HR, 3.104; 95% CI 1.140-8.449; p = 0.027). In conclusion, any periprocedural bleeding after TAVI was associated with mid-term CV mortality in nonagenarians, whereas severe bleeding was associated with mid-term all-cause mortality in patients < 90 years old.
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Affiliation(s)
- Motoki Fukutomi
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan.
| | - Takayuki Onishi
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan
| | - Tomo Ando
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Atsushi Shimizu
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Sato
- Department of Cardiology, Mie University Hospital, Thu, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University Hospital, Yamagata, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan
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Curio J, Demir OM. TAVR in Nonagenarians: What the World May Learn From Japan. JACC. ASIA 2022; 2:865-868. [PMID: 36713756 PMCID: PMC9877211 DOI: 10.1016/j.jacasi.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Charité University Medical Care, Campus Benjamin Franklin Berlin, Berlin, Germany
| | - Ozan M. Demir
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
- Address for correspondence: Dr Ozan M. Demir, Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.
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8
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Affiliation(s)
- R Adrichem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis. J Clin Med 2022; 11:jcm11072003. [PMID: 35407611 PMCID: PMC8999484 DOI: 10.3390/jcm11072003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Transcatheter aortic valve replacement (TAVR) improves the survival and life quality of nonagenarian patients with aortic stenosis. Stroke remains one of the most worrisome complications following TAVR. Cerebral embolic protection devices (CEPDs) may reduce neurological complications after TAVR. This study evaluated the safety and efficacy of CEPDs during TAVR in nonagenarian patients. Methods: Between January 2018 and October 2021, 869 patients underwent transfemoral TAVR (TF-TAVR) at our center. Of these, 51 (5.9%) patients were older than ninety years. In 33 consecutive nonagenarian patients, TF-TAVR was implanted without CEPDs using balloon-expandable valves (BEVs) and self-expandable valves (SEVs). Eighteen consecutive nonagenarians underwent TF-TAVR using a CEPD (CP group). Follow up period was in-hospital or 30 days after the procedure, respectively. Results: Minor access site complications occurred in two patients (3.9%) and were not CEPD-associated. Postinterventional delirium occurred in nine patients (17.6%). Periprocedural minor non-disabling stroke and delirium occurred in ten patients (19.6%). Periprocedural major fatal stroke occurred in two patients in the BEV group (3.9%). Two patients in the BEV group died due to postinterventional pneumonia with sepsis. The mortality rate was 7.8%. The results did not differ between the groups. Conclusions: Age alone is no longer a contraindication for TAVR. CEPD using the Triguard 3 system in nonagenarian TAVR patients was feasible and safe and did not increase access site complications.
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10
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Pereira SJ. Cardiac surgery in nonagenarians: Rethinking operative strategies in the era of TAVR and TMVR. J Card Surg 2022; 37:1671-1673. [PMID: 35288984 DOI: 10.1111/jocs.16399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
As growth of the elderly population continues to increase alongside improvements in percutaneous and minimally invasive interventions, cardiac surgeons question the role of high-risk surgery in treating these patients. TAVR has transformed the management of symptomatic severe aortic stenosis in elderly patients and has become standard therapy for patients greater than 80 years of age. With improvements in procedural risks and technical complications for both transcatheter valves and percutaneous interventions, should we rethink the operative strategies for octogenarians and nonagenarians, particularly as they apply to concurrent high-risk operations?
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Affiliation(s)
- Sara J Pereira
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah, USA
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11
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Oh S, Kim JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH, Jung Y, Lee KS. Successful subclavian transcatheter aortic valve replacement in a nonagenarian patient: Case report and review of literature. Medicine (Baltimore) 2022; 101:e28702. [PMID: 35089230 PMCID: PMC8797506 DOI: 10.1097/md.0000000000028702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE In super-aged patients with severe symptomatic aortic stenosis, transcatheter aortic valve replacement (TAVR) is a good treatment option, and the number of TAVR-eligible elderly patients is expected to grow exponentially. We present the case of a nonagenarian woman with severe aortic stenosis who underwent successful subclavian TAVR. PATIENT CONCERNS A 90-year-old Korean woman was brought to our department with dyspnea. On physical examination, a grade IV systolic murmur was auscultated in both the upper sternal borders and the left lower sternal border. DIAGNOSIS A transthoracic echocardiogram showed heavy calcification of the aortic valve with an increase in both peak velocity (4.36 m/s) and mean pressure (44.8 mm Hg), indicating severe symptomatic aortic stenosis. INTERVENTIONS After a heart team conference involving interventional cardiologists, cardiac surgeons, and anesthesiologists, subclavian TAVR was performed. Using the left subclavian artery, we successfully deployed a self-expandable valve prosthesis (CoreValveTM Evolut RTM, Medtronic Inc., Minneapolis, MN). OUTCOMES After TAVR, transthoracic echocardiogram showed a decline in both peak velocity (2.06-2.14 m/s) and mean pressure (7.42-7.95 mm Hg) with an increase in the aortic valve area (1.12 cm2). The patient's dyspnea symptoms improved dramatically. LESSONS In addition to femoral TAVR, subclavian TAVR may be feasible and safe in super-aged patients.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yochun Jung
- Department of Thoracic Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Kyo Sun Lee
- Department of Thoracic Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
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12
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Neurologic Complications in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:519-529. [PMID: 34593114 DOI: 10.1016/j.iccl.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for severe symptomatic aortic stenosis. Although many TAVR complication rates including mortality and aortic regurgitation have decreased, stroke rates have remained stable for years. TAVR-related strokes are devastating to patients and their families, and very costly for health care systems. The predictors of stroke in TAVR are not yet well defined, although older age, female gender, carotid and peripheral arterial disease, bicuspid aortic valve anatomy, and atrial fibrillation are emerging as risk factors across studies.
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13
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Costa G, Valvo R, Fiorina C, Adamo M, Giannini C, Testa L, Bruschi G, Poli A, De Felice F, Montorfano M, Maffeo D, Iadanza A, Reimers B, Bedogni F, Petronio AS, Tamburino C, Barbanti M. Long-term outcomes after transcatheter aortic valve replacement in nonagenarians: a multicenter age-based analysis. J Cardiovasc Med (Hagerstown) 2021; 22:204-211. [PMID: 33136808 DOI: 10.2459/jcm.0000000000001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To assess the outcome of nonagenarians patients receiving transcatheter aortic valve replacement (TAVR). METHODS We aimed to stratify the overall population from an Italian, multicenter, observational project including a total of 3792 consecutive patients who underwent TAVR with CoreValve and Evolut R/PRO devices between April 2009 and October 2018, into four groups according to their age class (≥90 vs. 80-89 years vs. 70-79 vs. <70 years) and to compare outcomes up to 4 years after TAVR. RESULTS At 4 years, survival estimates showed no difference in terms of overall survival [Kaplan-Meier estimates (KM est.) 49.9 vs. 58.1% vs. 57.0 vs. 69.3%; Plogrank = 0.28] among the four groups. After 2 years from the procedure, landmark analysis showed an age-based difference in overall survival (KM est. 63.8 vs. 75.0% vs. 75.1 vs. 88.7%; Plogrank = 0.025) but no difference in terms of survival from cardiovascular death (KM est. 87.8 vs. 87.4% vs. 86.1 vs. 96.1%; Plogrank = 0.43). Finally, age itself was not correlated with overall mortality at 4 years (hazard ratio 1.06, 95% confidence interval 0.86-1.30, P = 0.591). CONCLUSION TAVR with self-expanding CoreValve and Evolut prostheses was demonstrated to have good long-term outcomes, regardless of the patient's age. At 4 years, no difference in overall mortality was reported among age-based groups, while a higher overall mortality was reported in nonagenarians after 2 years from the procedure. TAVR showed good long-term outcomes even in nonagenarian patients, and it could be the therapy of choice for selected elderly patients.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
| | | | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia
| | - Cristina Giannini
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa
| | - Luca Testa
- Cardiology Department, IRCCS Policlinico S. Donato
| | | | - Arnaldo Poli
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan
| | - Diego Maffeo
- Cardiovascular Department, Fondazione Poliambulanza, Brescia
| | - Alessandro Iadanza
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Senese, Siena
| | - Bernhard Reimers
- Department of Cardiology, Istituto Clinico Humanitas, Milan, Italy
| | | | - Anna S Petronio
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
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14
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Noguchi M, Ueyama H, Ando T, Takagi H, Toshiki K. Clinical outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Cardiovasc Interv Ther 2021; 37:202-208. [PMID: 33428156 DOI: 10.1007/s12928-021-00755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
To compare the risk of procedural complications and mortality after transcatheter aortic valve implantation (TAVI) in nonagenarians (age ≥ 90 years) compared to younger patients (< 90 years). Although TAVI could be considered as a treatment option in nonagenarians, several previous studies have shown conflicting outcomes between nonagenarians and younger patients who underwent TAVI. We conducted a comprehensive literature search through PubMed and EMBASE to investigate the clinical outcomes of nonagenarians after TAVI. The outcomes of interest were short- and long-term mortality and procedural complications. Our study identified 16 observational studies including a total of 179,565 patients (21,674 nonagenarian patients and 157,891 younger patients. Nonagenarians had a significantly higher rate of short- (hazard ratio [HR], 95% confidence interval [CI]: 1.48, 1.38-1.59; P < 0.001) and long-term mortality (HR, 95% CI: 1.34, 1.24-1.44; P < 0.001) than younger patients after TAVI. Furthermore, there were significant differences in major and/or life-threatening bleeding (risk ratio [RR], 95% CI: 1.21, 1.05-1.39; P = 0.008), stroke (HR, 95% CI: 1.24, 1.11-1.40; P < 0.001), and major vascular complication (RR, 95% CI: 2.15, 1.35-3.42; P = 0.001) between nonagenarians and younger patients after TAVI. Minor vascular complication, myocardial infarction and permanent pacemaker implantation rate were similar between the two groups. Nonagenarians had significantly higher rate of short- and long-term mortality, major and/or life-threatening bleeding, stroke, and major vascular complication after TAVI. Although TAVI is a treatment option in nonagenarians, careful and appropriate selection of patients is essential to improve clinical outcomes.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Uyarasu, Japan
| | - Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Kuno Toshiki
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
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15
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Age Is Just a Number - Selection at Play in TAVR for Nonagenarians. Ann Thorac Surg 2020; 111:1528-1529. [PMID: 33058829 DOI: 10.1016/j.athoracsur.2020.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 11/24/2022]
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16
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Longitudinal Outcomes of Nonagenarians Undergoing Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2020; 111:1520-1528. [PMID: 32980326 DOI: 10.1016/j.athoracsur.2020.06.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/10/2020] [Accepted: 06/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as the preferred alternative to surgical aortic valve replacement in elderly patients. However, the long-term outcomes of nonagenarians undergoing TAVR are unknown. METHODS Octogenarian and nonagenarian patients undergoing TAVR from 2011 to 2018 were identified from a prospectively maintained institutional database. Cox proportional hazards regression was used for baseline-adjusted outcome comparison and risk prediction. Survival was compared with age and gender-matched population from the Social Security Actuarial Life Table. RESULTS A total of 649 (54.4%) octogenarians and 157 (13.2%) nonagenarians underwent TAVR. Nonagenarians had a lower body mass index (P < .001), smaller BSA (P < .001), and a lower prevalence of chronic obstructive pulmonary disease (P = .023) but a higher Society of Thoracic Surgeons score (P < .001). The majority of nonagenarians and octogenarians were treated using self-expandable valves (60.3% vs 60.9%; P = .888) via transfemoral access (86.0% vs 81.0%; P = .148). At 30 days, 1 year, and 4 years, there was no difference in survival (95.5%, 80.3%, and 51.2% vs 96.9%, 87.4, and 57.6%, respectively) (adjusted hazard ratio [HR], 0.8; P = .205) and hospital readmissions for cardiac causes (7.9%, 25.7%, and 53.7% vs 10.3%, 27.9%, and 52.0%, respectively) (adjusted HR, 0.9; P = .488). Further, nonagenarians had a survival comparable to an age-matched and sex-matched U.S. population (P = .540). Post-TAVR paravalvular leak (HRs: 3.23 [P = .042] vs 2.66 [P = .032]) and anemia (HRs: 0.64 [P = .002] vs 0.80 [P = .004]) were associated with worse outcomes at 1 year. CONCLUSIONS TAVR can be performed safely in nonagenarians, with comparable outcomes to younger patients approximating natural life expectancy. This age paradox should strengthen the role of TAVR in well selected nonagenarians by the heart team.
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17
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Pepe M, Corcione N, Biondi-Zoccai G, Morello A, Berti S, Bedogni F, Iadanza A, Tomai F, Sardella G, Romagnoli E, Ferraro P, Conte S, Nestola PL, Giosa MD, Cimmino M, Frati G, Giordano A. Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ≥85 Years Versus Those <85 Years. Am J Cardiol 2020; 129:60-70. [PMID: 32565091 DOI: 10.1016/j.amjcard.2020.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Abstract
The differential outcomes across the age spectrum of transcatheter aortic valve implantation (TAVI) recipients are still debated. Aim of the study was to evaluate the clinical outcomes of oldest-old patients undergoing TAVI in the large "Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea (RISPEVA)" registry. A total of 3,507 patients were stratified according to age: 1,381 were ≥85 years, 2,126 were <85 years. Primary endpoints were death at 30-days and complete follow-up (FU) (medium 368 days). Cerebrovascular events, myocardial infarction, bleedings, vascular complications at 30-days and complete FU were considered. In the unadjusted analysis, 30-days mortality in the oldest-old group was higher than in younger patients (4.2% vs 2.4%; p = 0.007); this difference kept true also at complete FU (19.6% vs 15.9%; p = 0.014). After propensity score (PS) matching, the oldest-old population showed a higher mortality solely at 30-days (4.7% vs 2.4%; p = 0.016), while the survival at complete FU was similar to that of younger patients (20.1% vs 18.0%; p = 0.286). The incidence of non-fatal outcomes resulted comparable between the 2 groups, also after propensity score matching. At the multivariate logistic regression analysis procedural major or disabling bleedings, cerebrovascular events, cardiogenic shock resulted predictors of 30-days death in the oldest-old cohort. In conclusion, patients ≥85 years can safely undergo TAVI being not more exposed to procedural complications than those <85 years; nevertheless they showed worse 30-days mortality, probably driven by reduced tolerance to complications. Passed the critical periprocedural phase, patients ≥85 years had a similar survival to those <85 years with comparable risk profile.
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18
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Pranata R, Vania R, Alkatiri AA, Firman D. Direct vs preimplantation balloon valvuloplasty in transcatheter aortic valve replacement-Systematic review and meta-analysis of randomized controlled trials and prospective-matched cohorts. J Card Surg 2020; 35:1498-1507. [PMID: 32419238 DOI: 10.1111/jocs.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the efficacy and safety of direct vs preimplantation balloon valvuloplasty (predilatation) before transcatheter aortic valve replacement (TAVR). METHODS We performed a systematic literature search up until March 2020 from PubMed, SCOPUS, EuropePMC, Cochrane Central Database, ProQuest, and ClinicalTrials.gov. We included randomized controlled trial (RCT) and prospective-matched cohorts that compared direct TAVR and preimplantation balloon valvuloplasty before TAVR. The primary outcome was the device success as defined by Valve Academic Research Consortium 2. The secondary outcome was a patient-prosthesis mismatch, the need for balloon postdilatation, composite adverse events, and 1-year mortality. RESULTS There were a total of 3078 patients from eight studies. This meta-analysis showed that direct TAVR has a similar device success rate (P = .63), the need for postdilatation (P = .82), and composite adverse events (P = .98) compared with preimplantation balloon valvuloplasty. Subgroup analysis for balloon-expandable valves showed lower need for balloon postdilatation (risk ratio [RR], 0.63 [0.47, 0.84]; P = .002; I2 , 0%) in direct TAVR group but higher incidence of acute kidney injury (RR, 3.23 [1.25, 8.40]; P = .02; I2 , 0%) and major/life-threatening bleeding (RR, 1.54 [1.17, 2.02]; P = .002; I2 , 0%). Subgroup analysis for the RCTs alone and RCTs + propensity-matched cohorts showed similar device success and composite adverse events in both groups. However, pooled RCTs showed a higher need for balloon postdilatation in direct TAVR (RR, 1.83 [1.03, 3.24]; P = .04; I2 , 0%). CONCLUSION Direct TAVR has similar efficacy and safety to preimplantation balloon valvuloplasty. However, better-designed RCTs are required before drawing a definite conclusion.
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Affiliation(s)
- Raymond Pranata
- Department of Medicine, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Rachel Vania
- Department of Medicine, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Noguchi M, Tabata M, Obunai K, Shibayama K, Ito J, Watanabe H, Yashima F, Watanabe Y, Naganuma T, Araki M, Yamanaka F, Shirai S, Ueno H, Mizutani K, Higashimori A, Takagi K, Tada N, Yamamoto M, Hayashida K. Clinical outcomes of transcatheter aortic valve implantation (TAVI) in nonagenarians from the optimized catheter valvular intervention-TAVI registry. Catheter Cardiovasc Interv 2020; 97:E113-E120. [PMID: 32333724 DOI: 10.1002/ccd.28935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/24/2020] [Accepted: 04/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate 30-day and 2-year clinical outcomes, and predictors of 2-year mortality in nonagenarians undergoing transcatheter aortic valve implantation (TAVI). BACKGROUND TAVI has been applied to nonagenarians. However, sufficient clinical data in nonagenarians who could benefit from TAVI are limited. METHODS We evaluated the data from the optimized catheter valvular intervention-TAVI registry. Clinical outcomes were compared between patients' age ≥90 years and age <90 years. Predictive factors of 2-year mortality were assessed by multivariable Cox regression analyses. RESULTS From October 2013 to May 2017, a total of 375 nonagenarians (age ≥90 years) and 2,213 younger patients (age <90 years) were included. Although nonagenarians had a higher surgical risk score, 30-day clinical outcomes were similar between two groups. There were no significant differences in 2-year mortality (22.0% vs. 17.3%; p = .11) and stroke (5.5% vs. 3.9%; p = .31); however, 2-year heart failure readmission was higher in nonagenarians (13.3% vs. 9.0%; p = .03). After adjusting covariates, age ≥90 years was not independent predictor for 2-year outcomes. In nonagenarians, female sex (hazard ratio [HR] = 0.43; 95% confidence interval [CI] = 0.26-0.74; p = .002), chronic kidney disease grade ≥4 (HR = 2.14; 95% CI = 1.21-3.64; p = .01), and Clinical Frailty Scale ≥4 (HR = 1.82; 95% CI = 1.02-3.42; p = .04) were independently associated with 2-year mortality. CONCLUSIONS Clinical outcomes of TAVI in selected nonagenarians were favorable. Severe renal dysfunction and frailty may be important factors to predict mid-term mortality after TAVI in nonagenarians.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kentaro Shibayama
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Joji Ito
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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20
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Deharo P, Bisson A, Herbert J, Lacour T, Saint Etienne C, Theron A, Porto A, Collart F, Bourguignon T, Cuisset T, Fauchier L. Outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a nationwide analysis. EUROINTERVENTION 2020; 15:1489-1496. [PMID: 31763981 DOI: 10.4244/eij-d-19-00647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to describe the midterm outcomes in nonagenarians undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients with aortic stenosis (AS), and specifically those treated with TAVI between 2010 and 2018. Cox regression was used for the analysis of predictors of events. We compared patients according to their age. Within the studied period, 71,095 patients older than 90 years with AS were identified. After matching on baseline characteristics, TAVI was associated with lower rates of a combined outcome of all-cause death, rehospitalisation for heart failure and stroke (relative risk [RR] 0.58, p<0.001) in comparison with matched nonagenarians with AS treated medically. During follow-up (median 161 days, interquartile range 13-625), the combined outcome occurred more frequently in nonagenarians (RR 1.22, p<0.01) who had a TAVI than in younger patients undergoing this procedure. All-cause death was reported in 17.6% versus 14.5% of nonagenarians, rehospitalisation for heart failure in 21.3% versus 18.2%, and stroke in 3.7% versus 2.9% (p<0.01 for all parameters). We identified the Charlson comorbidity index, heart failure, atrial fibrillation, stroke, vascular disease, cognitive impairment and denutrition as independent predictors of adverse outcomes in nonagenarians undergoing TAVI. CONCLUSIONS Among nonagenarians with AS, patients treated with TAVI had a lower risk of cardiovascular events than matched patients treated medically. The patients undergoing a TAVI at this age were often highly selected; the procedure was associated with acceptable long-term outcomes.
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21
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van Nieuwkerk A, Baan J, Delewi R. Can transcatheter aortic valve implantation improve cognition? Aging (Albany NY) 2020; 12:3117-3118. [PMID: 32081837 PMCID: PMC7066906 DOI: 10.18632/aging.102851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Astrid van Nieuwkerk
- Amsterdam University Medical Center, University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, The Netherlands
| | - Jan Baan
- Amsterdam University Medical Center, University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, The Netherlands
| | - Ronak Delewi
- Amsterdam University Medical Center, University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, The Netherlands
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22
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Galatas C, Afilalo J. Transcatheter aortic valve replacement over age 90: Risks vs benefits. Clin Cardiol 2019; 43:156-162. [PMID: 31840834 PMCID: PMC7021650 DOI: 10.1002/clc.23310] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
As the population ages, clinicians will encounter a growing number of nonagenarians suffering from severe aortic stenosis who may be candidates for transcatheter aortic valve replacement (TAVR). By virtue of a healthy survivor effect or a referral bias, these patients may paradoxically have greater resilience and fewer comorbidities than their octogenarian counterparts. They tend to, on average, tolerate the TAVR procedure quite well with low in‐hospital and 1‐year mortality rates of 5.5% and 23%, respectively. Appropriate patient selection should consider individualized estimates of procedural risk, potential for functional recovery and for improved quantity and quality of life. Frailty is much more revealing than chronological age, and it can be measured by brief tools such as the Essential Frailty Toolset. Ultimately, the process of shared decision‐making is paramount to ensure that the course of action is patient‐centered and balances the procedure's expected risks and benefits with the nonagenarian's preferences and values.
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Affiliation(s)
- Christos Galatas
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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23
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Yu PJ, Catalano M, Palazzo R, Cassiere H, Kohn N, Rutkin B, Maurer G, Berg JA, Hartman A. Risk stratification for nonagenarians undergoing transcatheter aortic valve replacement. J Card Surg 2019; 35:294-299. [PMID: 31730732 DOI: 10.1111/jocs.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are disparate data on the outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) compared with younger patients. The purpose of this study is to determine whether the Society of Thoracic Surgeons (STS) score can be used to identify the subset of nonagenarians that are at a significantly higher risk for poor postoperative outcomes after TAVR. METHODS A total of 425 patients above the age of 80 underwent elective TAVR between 12/2013 and 2/2018 and were included in this study. Patients were deemed intermediate or high risk based on an STS predicted the risk of surgical mortality score of 3% to 8% and more than 8%, respectively. Differences in postoperative outcomes and/or 6-month mortality between intermediate and high-risk octogenarians and nonagenarians were compared. RESULTS Of the 425 patients, 112 (26.4%) patients were nonagenarians, and 313 (73.6%) patients were octogenarians. Fifty-four (48.2%) of the nonagenarians were stratified as high-risk, while 78 (24.9%) of the octogenarians were stratified as high-risk. There were no statistically significant differences in the composite outcomes between intermediate-risk nonagenarians and intermediate-risk octogenarians. In contrast, high-risk nonagenarians were significantly more likely to experience the composite outcome of major perioperative complications and/or 6-month mortality as compared to high-risk octogenarians. CONCLUSION Intermediate-risk nonagenarians undergoing TAVR have similar postoperative outcomes compared to intermediate-risk octogenarians. However, high-risk nonagenarian patients undergoing TAVR experience significantly poorer outcomes compared to their octogenarian counterparts. Judicious patient selection for TAVR in this subgroup of patients is therefore warranted.
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Affiliation(s)
- Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Michael Catalano
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Robert Palazzo
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Hugh Cassiere
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Nina Kohn
- Department of Biostatistics, The Feinstein Institute for Medical Research, Manhasset, New York
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Greg Maurer
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Jacinda A Berg
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Alan Hartman
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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Stehli J, Koh JQS, Duffy SJ, Zamani J, Yeong CC, Paratz E, Martin C, Htun NM, Stub D, Dick R, Walton A. Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients Aged >90 Years Versus <90 Years. Am J Cardiol 2019; 124:1085-1090. [PMID: 31353006 DOI: 10.1016/j.amjcard.2019.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/16/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022]
Abstract
Limited data exist regarding transcatheter aortic valve implantation (TAVI) in nonagenarians. This study evaluates the short- and mid-term outcomes of nonagenarians after TAVI. Between 2008 and 2017, all patients who underwent TAVI in 2 centers in Australia were prospectively included in a registry and followed-up for 5 years. Outcomes were based on VARC-2 criteria. Additionally, the patient's reliance on daily living support at 1 year was evaluated. Of the 588 patients, 71 (12.1%) were ≥90 years old (mean age 92.2 ± 2 vs 83.2 ± 6 years in <90-year-old patients), with a median STS-PROM score of 5.7 (vs 3.9 in <90-year-old patients, odds ratio [OR] 1.07, 95% confidence interval 1.01 to 1.13, p = 0.02) and a median clinical frailty score of 4 (vs 4 <90-year-old patients, OR 0.88, p = 0.44). Mortality was 0% in ≥90-year-old patients at 30 days (vs 1.4% in <90-year-old patients; p = 0.82) and 12% at 1 year (vs 7.4%, in <90-year-old patients; hazard ratio 1.64, p = 0.20). There were no significant differences in periprocedural complications and mortality at 5 years between the 2 groups. At 1 year, nonagenarians were significantly more likely to live in an aged-care facility compared with <90-year-old patients (25% vs 16%, OR 5.99, 95% confidence interval 2.62 to 13.67, p <0.001). In conclusion, carefully selected nonagenarians have excellent short- and mid-term outcomes post-TAVI and should therefore not be refused based on age alone. Nevertheless, the significantly higher rate of transfer to an aged-care facility highlights the importance of a more refined frailty assessment before TAVI than the currently widely used clinical frailty score.
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Affiliation(s)
- Julia Stehli
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Cardiovascular Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Ji Quan Samuel Koh
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jalal Zamani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Chee Cheen Yeong
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Paratz
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nay M Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ron Dick
- Cardiovascular Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Cardiovascular Institute, Epworth Healthcare, Melbourne, Victoria, Australia.
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Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 74:2758-2767. [PMID: 31562908 DOI: 10.1016/j.jacc.2019.09.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes. OBJECTIVES This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade. METHODS The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex. RESULTS We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time. CONCLUSIONS In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.
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Redwood S, Allen C, Prendergast B. TAVR in Nonagenarians: Age May Be a Fatal Illness. JACC Cardiovasc Interv 2019; 12:921-922. [PMID: 31122348 DOI: 10.1016/j.jcin.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Simon Redwood
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom.
| | - Christopher Allen
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
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