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Transcatheter aortic valve implantation safe and effective in nonagenarians

Cardiovascular Disease in the Elderly


Barcelona, Spain – 28 Aug 2017: Transcatheter aortic valve implantation (TAVI) is safe and effective in nonagenarians, according to research presented at ESC Congress today.1 The observational study found that nonagenarians who underwent TAVI had worse short-term outcomes but similar one-year outcomes as patients younger than 90 years.

“The number of nonagenarians (age 90 or above) is rising and in the USA is set to quadruple by 2050 to reach 8.7 million,” said last author Dr Adriano Caixeta, an interventional cardiologist at Hospital Israelita Albert Einstein, São Paulo, Brazil.2 “As such, cardiologists are being confronted with an increasing number of nonagenarian patients with severe aortic stenosis.”

“TAVI has been established as a standard treatment for most elderly patients with aortic stenosis,” continued Dr Caixeta. “However, there is a debate about the clinical utility of TAVI in some very high risk subgroups of patients, including nonagenarians, as they have generally represented a small fraction of patients enrolled in clinical trials.”

There is little data on the safety and efficacy of TAVI in patients older than 90 years of age and longer-term (over one year) follow-up is lacking.

This study evaluated the early (30 days) and long-term (over one year) clinical outcomes in nonagenarian patients undergoing TAVI. Between January 2008 and February 2015, patients with symptomatic aortic stenosis who underwent TAVI were enrolled in a Brazilian multicentre registry.

Among a total of 819 patients, 735 were less than 90 years old, and 84 (10.2%) were nonagenarian. Nonagenarian patients were on average 12 years older than patients less 90 years old (92.4 years versus 80.1 years; p<0.001).

Compared with younger patients, nonagenarian patients were sicker (Society of Thoracic Surgeons' [STS] risk score of 13.19% versus 9.87%; p <0.001), and had lower body mass index (24.61 ± 3.87 vs. 26.49 ± 4.78 kg/m2; p=0.001).

At 30 days after TAVI, the rate of all-cause mortality was higher in the nonagenarian group (15.6% versus 8.4%; p=0.04). At one year, there were similar rates of death between nonagenarians and younger patients (20.9% vs. 21.8%) (figure 1). There were no differences in the rates of stroke, myocardial infarction or bleeding at 30 days and one year.

After two years of follow-up, there was a higher mortality rate in nonagenarians, which likely reflects the shorter underlying life expectancy of these patients.

Dr Caixeta said: “In this real world observational study, nonagenarian patients who underwent TAVI had worse short-term outcomes but similar one-year clinical outcomes as patients younger than 90 years. The findings suggest that TAVI is safe and effective in nonagenarian patients with aortic stenosis and is not a futile treatment.”

Figure 1: Kaplan-Meier curves of all-cause mortality in nonagenarians (green) versus patients less 90 years (blue) undergoing TAVI

Caixeta figure 1.jpg

 

 

 

 

 

 

 

 

 

 

 

 

 

ENDS

Notes to editor

Sources of funding: The study was sponsored by the Brazilian Society of Interventional Cardiology.

Disclosures: None.

References and notes
(1) The abstract “Short- and long-term clinical outcomes in nonagenarian patients undergoing transcatheter aortic valve implantation” will be presented during:
·    The press conference - Cardiac interventions - expanding applications on Saturday 26 August from 15:00 to 16:00.
·   Poster session 5: Transcatheter valve interventions and their complications on Monday 28 August from 14:00 to 18:00 in the Poster Area.
(2) Vincent, GK, et al. The Next Four Decades: The Older Population in the United States 2010 to 2050. US Census Bureau; Washington, DC: 2010.

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About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 140 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2017
ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2017 takes place 26 to 30 August at the Fira Gran Via in Barcelona, Spain. The scientific programme is here. More information is available from the ESC Press Office at press@escardio.org.

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2017. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.