Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

BackgroundClinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥90 years.MethodsWe conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR among nonagenarians was compared to the provincial estimated survival for an age- and sex- matched general population. Quality of life (QoL) was assessed up to 1 year post-intervention by standardized questionnaires.ResultsDuring the study period, n=268 patients aged ≥90 years were evaluated for severe aortic stenosis. TAVR was performed in n=171 (48% females; median[IQR] Rockwood frailty scale: 4[3-4]), n=84 underwent medical therapy (MT), and n=13 underwent surgical AVR. Survival was significantly better following TAVR compared to MT (adjusted HR[95%CI]: 1.99[1.37-2.88], p<0.001). TAVR demonstrated a survival benefit over that of the general population with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1-year compared to baseline (all p<0.05): the 6-minute walk test improved from 192 to 252m, the Kansas City Cardiomyopathy Questionnaire score from 64 to 81, the Duke Activity Status Index score from 13 to 16, and the health state scale of the Euro QoL-5D from 63 to 74%.ConclusionsNonagenarians undergoing TAVR experience a slightly better survival compared to that of an age-matched general population and have significant improvements in functional status and several QoL indices following the procedure.