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Is the Use of BITA vs SITA Grafting Safe and Beneficial in Octogenarians? Ann Thorac Surg 2021; 111:1998-2003. [DOI: 10.1016/j.athoracsur.2020.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/07/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
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The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9829487. [PMID: 29423414 PMCID: PMC5750486 DOI: 10.1155/2017/9829487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p < 0.0001), cardiac-related mortality (p < 0.0001), incidence of acute myocardial infarction (p = 0.01), and stroke rates (p < 0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p = 0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.
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Luc JGY, Graham MM, Norris CM, Al Shouli S, Nijjar YS, Meyer SR. Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study. BMC Cardiovasc Disord 2017; 17:275. [PMID: 29096604 PMCID: PMC5667481 DOI: 10.1186/s12872-017-0706-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background Available cardiac surgery risk scores have not been validated in octogenarians. Our objective was to compare the predictive ability of the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE II in elderly patients undergoing isolated coronary artery bypass grafting surgery (CABG). Methods All patients who underwent isolated CABG (2002 – 2008) were identified from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. All patients aged 80 and older (n = 304) were then matched 1:2 with a randomly selected control group of patients under age 80 (n = 608 of 4732). Risk scores were calculated. Discriminatory accuracy of the risk models was assessed by plotting the areas under the receiver operator characteristic (AUC) and comparing the observed to predicted operative mortality. Results Octogenarians had a significantly higher predicted mortality by STS Score (3 ± 2% vs. 1 ± 1%; p < 0.001), additive EuroSCORE (8 ± 3% vs. 4 ± 3%; p < 0.001), logistic EuroSCORE (15 ± 14% vs. 5 ± 6%; p < 0.001), and EuroSCORE II (4 ± 3% vs. 2 ± 2%; p < 0.001) compared to patients under age 80 years. Observed mortality was 2% and 1% for patients age 80 and older and under age 80, respectively (p = 0.323). AUC revealed areas for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively, for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age 80 (0.829, 0.750, 0.785, 0.845). Conclusion All risk prediction models assessed overestimated surgical risk, particularly in octogenarians. EuroSCORE II demonstrated better discriminatory accuracy in this population. Inclusion of new variables into these risk models, such as frailty, may allow for more accurate prediction of true operative risk.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Colleen M Norris
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sadek Al Shouli
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Yugmel S Nijjar
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Mazankowski Alberta Heart Institute, Edmonton, Canada.
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Xia L, Ji Q, Song K, Shen J, Shi Y, Ma R, Ding W, Wang C. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J Cardiothorac Surg 2017; 12:11. [PMID: 28231841 PMCID: PMC5322671 DOI: 10.1186/s13019-017-0572-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction. Methods A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared. Results Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less. Conclusions The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.
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Affiliation(s)
- LiMin Xia
- Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China
| | - Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - Kai Song
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - JinQiang Shen
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - YunQing Shi
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - RunHua Ma
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - WenJun Ding
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - ChunSheng Wang
- Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China.
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Hoffmann G, Friedrich C, Barrabas M, Petzina R, Haneya A, Panholzer B, Berndt R, Cremer J. Short- and long-term follow-up after minimally invasive direct coronary artery bypass in octogenarians. Interact Cardiovasc Thorac Surg 2016; 23:377-82. [PMID: 27209534 DOI: 10.1093/icvts/ivw149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Demographic changes lead to a rising incidence of octogenarians undergoing surgical revascularization of coronary artery disease. Minimally invasive direct coronary artery bypass (MIDCAB) represents a surgical treatment with reduced trauma and without the use of cardiopulmonary bypass. The aim of this study was to evaluate short- and long-term outcomes after MIDCAB in octogenarians. METHODS Between 1998 and 2012, 1060 patients underwent MIDCAB at our department. Among them, 72 patients (6.8%) were older than 80 years at the time of operation. Incidence of major adverse cardiac and cerebrovascular events (MACCEs) was compared between octogenarians [median age 82 (81; 85) years, 63.9% male] and younger MIDCAB patients [median age 64 (56; 70) years, 70.7% male] after 30 days and during follow-up. The impact of demographics and preoperative comorbidities on mortality during follow-up was analysed. RESULTS At baseline, the elderly group presented with a statistically significant higher logistic EuroSCORE I (9.2 vs 2.2%, P < 0.001). Within 30 days, octogenarians showed a mortality rate of 5.6% (younger patients 0.8%, P = 0.006) and an MACCE rate of 5.6% (younger patients 1.3%, P = 0.024). The median follow-up time of 30-day survivors was 5.5 (2.9; 7.6) years and follow-up completeness reached 96.9%. In the elderly group, 1-, 3- and 5-year survival rates were 89, 78 and 63% in comparison with 97, 94 and 90% in the younger group (P < 0.001), respectively. The estimated median survival time in octogenarians was 6.7 (CI 4.854; 8.629) years. Logistic regression showed preoperative renal impairment, peripheral arterial occlusive disease and pulmonary hypertension to have a stronger impact on mortality during follow-up than age above 80 years. CONCLUSIONS MIDCAB represents a safe treatment option in octogenarians and is associated with a good perioperative outcome and satisfying long-term results in octogenarians.
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Affiliation(s)
- Grischa Hoffmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Moritz Barrabas
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rainer Petzina
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
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Finn M, Green P. The Influence of Frailty on Outcomes in Cardiovascular Disease. ACTA ACUST UNITED AC 2015; 68:653-6. [PMID: 26129717 DOI: 10.1016/j.rec.2015.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/28/2015] [Indexed: 01/11/2023]
Affiliation(s)
- Matthew Finn
- Department of Cardiology, Columbia University Medical Center, New York, United States.
| | - Philip Green
- Department of Cardiology, Columbia University Medical Center, New York, United States
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Fleissner F, Warnecke G, Cebotari S, Rustum S, Haverich A, Ismail I. Coronary artery bypass grafting in young patients--insights into a distinct entity. J Cardiothorac Surg 2015; 10:65. [PMID: 25929721 PMCID: PMC4434868 DOI: 10.1186/s13019-015-0266-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/17/2015] [Indexed: 11/10/2022] Open
Abstract
Objectives Coronary artery bypass grafting (CABG) is the ‘Gold Standard’ for patients with multiple vessel coronary artery disease (CAD). Younger patients presenting with coronary artery disease requiring surgery may represent a distinct subgroup with the main goal for coronary revascularization being long term patency of the performed grafts to improve outcome. Methods Between January 2010 and August 2013, 126 patients below the age of 50 years underwent CABG for CAD in our hospital. We retrospectively analyzed the perioperative data and evaluated patients’ outcome. Results In 25% of the patients CABG was performed as an emergency procedure for STEMI or NSTEMI within 36 hours. Another 27% of the patients were operated urgently for unstable angina or myocardial infarction within the last weeks and only 48% of the patients were purely elective cases. We performed only venous bypass grafts in 12%, total arterial revascularisation in 52% of all cases and combined venous and arterial revascularization in 43%. Six patients needed cardiac support using an extracorporeal membrane oxygenation (Mortality n = 1 out of 6) and 17 patients received an intraaortic ballon pump perioperativly. Patients received 2.8 ± 1 bypass grafts overall. Overall in-hospital mortality in this cohort was low with 1% (n = 1). Conclusions In conclusion, the majority of the young patients below the age of 50 years present urgently for operative revascularization. Besides the potential advances regarding long term patency using total arterial revascularization, only about half of the young patients are feasible for this approach. Overall early outcome in this group is excellent with mortality below one percent.
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Affiliation(s)
- Felix Fleissner
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Gregor Warnecke
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Serghei Cebotari
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Saad Rustum
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Issam Ismail
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Thorsteinsson K, Fonager K, Mérie C, Gislason G, Køber L, Torp-Pedersen C, Mortensen RN, Andreasen JJ. Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study. Eur J Cardiothorac Surg 2015; 49:391-7. [PMID: 25698155 DOI: 10.1093/ejcts/ezv060] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG. METHODS All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves. RESULTS A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (≥80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients <60 years, 8% in octogenarians). The long-term mortality rate at 1 and 5 years was 2 and 7% (age <60 years) and 14 and 36% (age >80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25). CONCLUSION Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
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Affiliation(s)
- Kristinn Thorsteinsson
- Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gentofte, Denmark
| | - Charlotte Mérie
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Rikke N Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ji Q, Mei Y, Wang X, Ding W. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in High-Risk Patients. Int Heart J 2014; 55:484-8. [DOI: 10.1536/ihj.14-088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Qiang Ji
- Departments of Thoracic Cardiovascular Surgery, Tongji Hospital of Tongji University
| | - YunQing Mei
- Departments of Thoracic Cardiovascular Surgery, Tongji Hospital of Tongji University
| | - Xisheng Wang
- Departments of Thoracic Cardiovascular Surgery, Tongji Hospital of Tongji University
| | - Wenjun Ding
- Department of Cardiovascular Surgery, Zhongshan Hospital of Fudan University
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Noble S, Frangos E, Samaras N, Ellenberger C, Frangos C, Cikirikcioglu M, Bendjelid K, Frei A, Myers P, Licker M, Roffi M. Transcatheter aortic valve implantation in nonagenarians: effective and safe. Eur J Intern Med 2013; 24:750-5. [PMID: 23932885 DOI: 10.1016/j.ejim.2013.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/01/2013] [Accepted: 07/05/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of nonagenarians is rising dramatically. These patients often develop severe aortic stenosis for which transcatheter aortic valve implantation (TAVI) is an attractive option. The aim of this study was to analyze the outcome of TAVI performed in a cohort of nonagenarian patients. METHODS Between August 2008 and November 2012, 23 consecutive patients in their 90th year of age or older underwent TAVI in our institution after having been assessed by the local heart team. Data concerning baseline characteristics, procedural details and outcome were prospectively entered into a dedicated database. Transthoracic echocardiography and clinical follow-up were performed pre-procedure, at discharge, at 6 and 12 months and then annually post TAVI. RESULTS Patients were male in 52% with a mean age of 90.3 ± 2.3 years. Mean logistic EuroSCORE and STS score were 26.6 ± 14.5% and 8.7 ± 2.9%, respectively. Transcatheter heart valve (THV) could be implanted in all but one patient. Mortality at 30 days was 8.7% overall and 4.8% for transfemoral approach. At 30 days the rate of stroke was 4.3%, paravalvular leak grade ≥ 2 was 8.7%, life-threatening bleeding was 13.0% and pacemaker implantation was 13%. Device success was 73.9%. The rate of all-cause mortality increased to 27.3% at one-year follow-up and 42.8% at a median follow-up of 417 days. CONCLUSIONS TAVI is safe and effective even in a selected population of nonagenarians. Consequently, these patients should not be refused such a procedure based only on their age. Multi-disciplinary assessment is essential in order to properly select candidates.
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Affiliation(s)
- Stephane Noble
- Cardiology Division, Interventional Cardiology Unit, University Hospital of Geneva, Switzerland.
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