TAVI in patients aged ≥85 years yielded long-term major adverse cardiovascular event rates comparable to those in patients <85 years (46.8% vs. 41.2%, p=0.244).
Cohort (n=210)
No
Does TAVI in patients aged ≥85 years yield comparable long-term outcomes to patients <85 years with severe symptomatic AS?
TAVI in carefully selected patients aged ≥85 years yields long-term outcomes comparable to younger patients, suggesting advanced age alone should not preclude the procedure.
Absolute Event Rate: 46.8% vs 41.2%
p-value: p=0.244
Abstract Introduction Over the past two decades, transcatheter aortic valve implantation (TAVI) has emerged as a key therapeutic option for severe symptomatic aortic stenosis (AS) in high-surgical-risk patients, progressively expanded to include all surgical risk categories. While its use is increasing among older populations, evidence on outcomes in the very elderly remains controversial. Material and Methods We conducted a single-center, high-volume, retrospective study including all patients with severe symptomatic AS who underwent TAVI in 2019, following thorough strict evaluation and approval by the local Heart Team. Patients were stratified into two groups according to age: those younger than 85 years (Under 85 U85) and those aged 85 or older (Over 85 O85). Long-term follow-up data were collected on major adverse cardiovascular events (MACE), all-cause mortality and heart failure-related hospitalizations, defined as the first event occurring after the procedure. Results A total of 210 patients were enrolled, including 96 individuals aged ≥85 years (O85). The mean age was 80.2±3.6 in U85 and 87.9±2.4 in O85 (p0.001). The cohort comprised 128 females (61% of the total; U85: 67 vs. O85: 61; p = 0.480). Both groups exhibited a high burden of comorbidities, with no statistically significant differences. Procedural success was achieved in all patients. Pre-procedural echocardiographic parameters were comparable, and post-TAVI hemodynamic outcomes showed no significant differences between groups. At a mean follow-up of 4.2 ± 1.4 years, MACE occurred more frequently in O85 than in U85 (46.8% vs. 41.2%), but the difference was not statistically significant (p = 0.244). All-cause mortality rates were also comparable (U85: 35 30.7% vs. O85: 36 37.5%, p = 0.300). Heart failure hospitalization rates were numerically higher in U85 (U85: 12 10.5% vs. O85: 9 9.4%), though without statistical significance (p = 0.979). Kaplan-Meier analysis demonstrated no significant differences in survival between the two groups (log-rank p = 0.345). Conclusion TAVI in patients aged ≥85 years yields long-term outcomes comparable to those in their relatively younger counterparts. Patients in this age group appear to have effectively overcome competing risks and may demonstrate greater resilience to life stressors. Moreover, the rigorous selection process by the Heart Team likely minimizes futile cases, ensuring appropriate patient selection.
Amico et al. (Sat,) conducted a cohort in Severe symptomatic aortic stenosis (n=210). Transcatheter aortic valve implantation (TAVI) in patients aged ≥85 years vs. TAVI in patients aged <85 years was evaluated on Major adverse cardiovascular events (MACE) (p=0.244). TAVI in patients aged ≥85 years yielded long-term major adverse cardiovascular event rates comparable to those in patients <85 years (46.8% vs. 41.2%, p=0.244).