Outcomes in nonagenarians undergoing transcatheter aortic valve replacement in the PARTNER-I trial presented at the Fifty-first Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, Jan 24-28, 2015.

Vinod H. Thourani, Hanna A. Jensen, Vasilis Babaliaros, Susheel K. Kodali, Jeevanantham Rajeswaran, John Ehrlinger, Eugene H. Blackstone, Rakesh M. Suri, Creighton W. Don, Gabriel Aldea, Mathew R. Williams, Raj Makkar, Lars G. Svensson, James M. McCabe, Larry S. Dean, Samir Kapadia, David J. Cohen, Augusto D. Pichard, Wilson Y. Szeto, Howard C. HerrmannChandan Devireddy, Bradley G. Leshnower, Gorav Ailawadi, Hersh S. Maniar, Rebecca T. Hahn, Martin B. Leon, Michael Mack

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36 Scopus citations

Abstract

Background This study describes short-term and mid-term outcomes of nonagenarian patients undergoing transfemoral or transapical transcatheter aortic valve replacement (TAVR) in the Placement of Aortic Transcatheter Valve (PARTNER)-I trial. Methods From April 2007 to February 2012, 531 nonagenarians, mean age 93 ± 2.1 years, underwent TAVR with a balloon-expandable prosthesis in the PARTNER-I trial: 329 through transfemoral (TF-TAVR) and 202 transapical (TA-TAVR) access. Clinical events were adjudicated and echocardiographic results analyzed in a core laboratory. Quality of life (QoL) data were obtained up to 1 year post-TAVR. Time-varying all-cause mortality was referenced to that of an age-sex-race-matched US population. Results For TF-TAVR, post-procedure 30-day stroke risk was 3.6%; major adverse events occurred in 35% of patients; 30-day paravalvular leak was greater than moderate in 1.4%; median post-procedure length of stay (LOS) was 5 days. Thirty-day mortality was 4.0% and 3-year mortality 48% (44% for the matched population). By 6 months, most QoL measures had stabilized at a level considerably better than baseline, with Kansas City Cardiomyopathy Questionnaire (KCCQ) 72 ± 21. For TA-TAVR, post-procedure 30-day stroke risk was 2.0%; major adverse events 32%; 30-day paravalvular leak was greater than moderate in 0.61%; and median post-procedure LOS was 8 days. Thirty-day mortality was 12% and 3-year mortality 54% (42% for the matched population); KCCQ was 73 ± 23. Conclusions A TAVR can be performed in nonagenarians with acceptable short- and mid-term outcomes. Although TF- and TA-TAVR outcomes are not directly comparable, TA-TAVR appears to carry a higher risk of early death without a difference in intermediate-term mortality. Age alone should not preclude referral for TAVR in nonagenarians.

Original languageEnglish
Pages (from-to)785-793
Number of pages9
JournalAnnals of Thoracic Surgery
Volume100
Issue number3
DOIs
StatePublished - Sep 1 2015

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