Should TAVR be Performed in Nonagenarians?

Although nonagenarians had higher mortality rates following transcatheter aortic valve replacement (TAVR) than their younger counterparts, quality-of-life data at one year may suggest its efficacy for selected patients, according to a study published March 21 in the Journal of the American College of Cardiology.

Using data from the STS/ACC TVT Registry, researchers examined records from 24,025 patients, of which 3,773 patients were 90 or older, from 329 hospitals between November 2011 and September 2014.

Results showed that at 30 days, the mortality rate was higher in the nonagenarian group (8.8 percent) than in the younger group (5.9 percent), as it was at one year: 24.8 percent vs. 22 percent. There was not, however, a statistically significant difference in stroke incidence at 30 days (2.9 percent vs. 2.4 percent) or at one year (4.4 percent vs. 3.9 percent). The 30-day KCCQ-12 score was slightly lower in nonagenarians compared to younger patients but was similar at one year.  

Mani Arsalan, MD, the study’s lead author, notes that while nonagenarians take longer to recover than younger patients, the differences leveled out at one year, as shown by comparable quality-of-life data. Therefore, “the reported data support the safety and the efficacy of this procedure in select elderly patients, suggesting that it should not be denied solely based on patient age,” he says. 

In an accompanying editorial, William S. Weintraub, MD, MACC, raises the question of whether it was cost-effective to perform TAVR in this population, even though the literature has shown it can be done with a high but likely acceptable risk. Nonetheless, he concludes that, “the patient’s overall health status, as well as the desires of the patient and family, should be paramount in the decision whether to proceed.”    

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention

Keywords: Aged, Aged, 80 and over, Health Status, Incidence, Patient Selection, Risk, Stroke, Transcatheter Aortic Valve Replacement, STS/ACC TVT Registry, National Cardiovascular Data Registries

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