Conduction disorders and transcatheter aortic valve. Clinically relevant or just a mild complication?

Will percutaneous valves replace the surgical valves: Another one bites the dust?

Trans-cutaneous valve implantation (TAVI) has witnessed rapid evolution in terms of technical design, efficacy, and safety outcomes. This has led to expanding indications of TAVI from inoperable to high surgical to now even lower surgical risk patients. However, its cost and applicability only in elderly patients with degenerated valves is a cause of concern limiting the use of this technology. Further evolution may lead to its application in lower risk essentially younger patients with broader etiologic sub-groups.

Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up

Objective

To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS).

Methods

This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years.

Results

The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality.

Conclusions

TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.