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Age-Related Outcomes After TAVR: SwissTAVI Registry Insights
Quick Takes
- Increasing age is associated with a linear trend for all-cause mortality, stroke, and pacemaker implantation during the periprocedural and longer-term follow-up period after TAVR.
- Standardized mortality ratios were higher for TAVR patients aged <90 years when compared to expected rates of mortality in an age- and sex-matched Swiss population.
- However, after 90 years of age, patients with valvular heart disease undergoing TAVR had similar rates of mortality than the national reference population.
Study Questions:
What are the age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study?
Methods:
The investigators analyzed data from the SwissTAVI Registry. Clinical outcomes were compared between patients aged <70 years (n = 324), 70-79 years (n = 1,913), 80-89 years (n = 4,353), and ≥90 years (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios (SMRs).
Results:
Between February 2011 and June 2018, 7,097 patients (aged 82.0 ± 6.4 years, 49.6% females) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio [aHR], 1.45; 95% confidence interval [CI], 1.18-1.77; 1-year aHR, 1.12; 95% CI, 1.01-1.24), cerebrovascular accidents (30-day aHR, 1.35; 95% CI, 1.09-1.66; 1-year aHR, 1.21; 95% CI, 1.02-1.45), and pacemaker implantation (30-day aHR, 1.23; 95% CI, 1.12-1.34; 1-year aHR, 1.19; 95% CI, 1.09-1.30) was observed with increasing age. Furthermore, SMRs were 12.63 (95% CI, 9.06-17.58), 4.09 (3.56-4.74), 1.63 (1.50-1.78), and 0.93 (0.76-1.14) for TAVR patients in relation to the Swiss population aged <70, 70-79, 80-89, and ≥90 years of age, respectively.
Conclusions:
The authors concluded that increasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer-term follow-up after TAVR.
Perspective:
This cohort study reports that increasing age is associated with a linear trend for all-cause mortality, stroke, and pacemaker implantation during the periprocedural and longer-term follow-up period after TAVR. Furthermore, standardized mortality ratios were higher for TAVR patients aged <90 years when compared to expected rates of mortality in an age- and sex-matched Swiss population. However, after 90 years of age, patients with valvular heart disease undergoing TAVR had similar rates of mortality than the national reference population. There is a need for additional prospective studies to determine the prognostic value of TAVR in the very elderly patient population and to inform on benefits in health-related quality of life in this vulnerable patient population.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease
Keywords: Cardiac Rehabilitation, Cardiac Surgical Procedures, Geriatrics, Heart Failure, Heart Valve Diseases, Pacemaker, Artificial, Patient Discharge, Quality of Life, Stroke, Transcatheter Aortic Valve Replacement, Vascular Diseases
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