Clinical outcomes of transcatheter aortic valve implantation (TAVI) in nonagenarians from the optimized catheter valvular intervention-TAVI registry.
aortic valve stenosis
nonagenarians
transcatheter aortic valve implantation
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
received:
04
11
2019
revised:
24
02
2020
accepted:
12
04
2020
pubmed:
26
4
2020
medline:
25
9
2021
entrez:
26
4
2020
Statut:
ppublish
Résumé
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). TAVI has been applied to nonagenarians. However, sufficient clinical data in nonagenarians who could benefit from TAVI are limited. 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. 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. 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.
Sections du résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E113-E120Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Statistics Bureau of Japan. https://www.stat.go.jp/data/nihon/02.html. Accessed February 24, 2020.
Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597-1607.
Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187-2198.
Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609-1620.
Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376:1321-1331.
Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695-1705.
Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380:1706-1715.
Yamamoto M, Mouillet G, Meguro K, et al. Clinical results of transcatheter aortic valve implantation in octogenarians and nonagenarians: insights from the France-2 Registry. Ann Thorac Surg. 2014;97:29-36.
Abramowitz Y, Chakravarty T, Jilaihawi H, et al. Comparison of outcomes of transcatheter aortic valve implantation in patients ≥90 years versus <90 years. Am J Cardiol. 2015;116:1110-1115.
Arsalan M, Szerlip M, Vemulapalli S, et al. Should transcatheter aortic valve replacement be performed in nonagenarians?: insights from the STS/ACC TVT Registry. J Am Coll Cardiol. 2016;67:1387-1395.
Vendrik J, van Mourik MS, van Kesteren F, et al. Comparison of outcomes of transfemoral aortic valve implantation in patients <90 with those >90 years of age. Am J Cardiol. 2018;121:1581-1586.
Vlastra W, Chandrasekhar J, Vendrik J, et al. Transfemoral TAVR in nonagenarians: from the CENTER collaboration. JACC Cardiovasc Interv. 2019;12:911-920.
Clinical Frailty Scale-Geriatric Medicine Research-Dalhousie University. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html. Accessed February 24, 2020.
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173:489-495.
Watanabe Y, Kozuma K, Hioki H, et al. Comparison of results of transcatheter aortic valve implantation in patients with versus without active cancer. Am J Cardiol. 2016;118:572-577.
Kano S, Yamamoto M, Shimura T, et al. Gait speed can predict advanced clinical outcomes in patients who undergo transcatheter aortic valve replacement: insights from a Japanese multicenter registry. Circ Cardiovasc Interv. 2017;10:e005088.
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60:1438-1454.
Sannino A, Szerlip M, Harrington K, Schiattarella GG, Grayburn PA. Comparison of baseline characteristics and outcomes in men versus women with aortic stenosis undergoing transcatheter aortic valve implantation. Am J Cardiol. 2018;121:844-849.
Franzone A, Pilgrim T, Arnold N, et al. Rates and predictors of hospital readmission after transcatheter aortic valve implantation. Eur Heart J. 2017;38:2211-2217.
Barbanti M, Petronio AS, Ettori F, et al. 5-year outcomes after transcatheter aortic valve implantation with CoreValve prosthesis. JACC Cardiovasc Interv. 2015;8:1084-1091.
Arnold SV, Afilalo J, Spertus JA, et al. Prediction of poor outcome after transcatheter aortic valve replacement. J Am Coll Cardiol. 2016;68:1868-1877.
Shimura T, Yamamoto M, Kano S, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation. 2017;135:2013-2024.
Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol. 2017;70:689-700.