Long-Term Outcomes After Transcatheter Aortic Valve Replacement in Nonagenarians

Figures

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  Figure 1. Cumulative Incidence of All-Cause Death After Transcatheter Aortic Valve Replacement by Age Group Kaplan-Meier curves compare patients aged ≥90 years (red) with those aged <90 years (blue). Numbers at risk are displayed annually. The curve for nonagenarians consistently lies above that for younger patients, with progressive separation (log-rank P < 0.001). TAVI = transcatheter aortic valve implantation; TAVR = transcatheter aortic valve replacement.

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  Figure 2. Cumulative Incidence of Outcomes by Age Group Cumulative incidence functions are shown for (A) cardiovascular death, (B) noncardiovascular death, (C) heart failure readmission, and (D) stroke, stratified by age (red: ≥90 years; blue: <90 years). P values were calculated using Gray test. At 5 years, noncardiovascular death and heart failure readmission were significantly higher in patients aged ≥90 years, whereas cardiovascular death and stroke were not significantly different between groups. Abbreviation as in Figure 1.

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  Figure 3. Stacked Cumulative Incidence of Noncardiovascular and Cardiovascular Deaths Stacked cumulative incidence functions are shown for noncardiovascular and cardiovascular deaths, stratified by age group (left: ≥90 years, right: <90 years). The between-group difference is largely explained by noncardiovascular deaths, whereas cardiovascular deaths accumulate at similar rates across groups. Noncardiovascular and cardiovascular deaths are displayed in red and blue, respectively. Abbreviation as in Figure 1.

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  Figure 4. Multivariable Predictors of All-Cause Death in Nonagenarians After Transcatheter Aortic Valve Replacement Forest plot of HRs with 95% CIs from a Cox proportional hazards model including prespecified covariates: male sex, Clinical Frailty Scale (per 1-point increment), GNRI (per 10-point increment), NYHA functional class III/IV, LVEF (per 10% increase), atrial fibrillation, diabetes mellitus, chronic kidney disease, and COPD. Red markers indicate key geriatric factors (frailty and nutrition), black markers significant predictors (P < 0.05), and gray markers nonsignificant predictors. CFS = Clinical Frailty Scale; COPD = chronic obstructive pulmonary disease; GNRI = Geriatric Nutritional Risk Index; LVEF = left ventricular ejection fraction.

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  Figure 5. 5-Year Survival by Frailty and Nutrition Among Nonagenarians After Transcatheter Aortic Valve Replacement A multivariable Fine-Gray model was used to estimate 5-year overall survival among nonagenarians after TAVR. The heatmap illustrates survival across GNRI (≤70 to ≥110) and CFS (≤2 to ≥7), with other covariates fixed at cohort medians. Lighter shades correspond to higher survival (60-80%), whereas darker shades indicate lower survival (20%-40% or <20%). A clear gradient is observed from low GNRI/high frailty (worst prognosis) to high GNRI/low frailty (best prognosis). Abbreviations as in Figure 4.

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  Central Illustration. Long-Term Outcomes After Transcatheter Aortic Valve Replacement in Nonagenarians Nonagenarians undergoing TAVR had higher long-term mortality driven predominantly by noncardiovascular causes. Chronological age ≥90 years was not an independent predictor of outcomes; instead, frailty and malnutrition were the principal determinants of long-term prognosis. CFS = Clinical Frailty Scale; GNRI = Geriatric Nutritional Risk Index; TAVR = transcatheter aortic valve replacement.