Key result
In patients undergoing transcatheter aortic valve replacement, there was no significant difference in 1-year mortality between those over 85 years of age and those aged 85 and younger (5.6% vs 6.6%, p=0.521).
Why the study?
Although an aging population yields many fit patients eligible for TAVR, studies comparing outcomes between older and younger patients are scant.
Does transcatheter aortic valve replacement (TAVR) have comparable outcomes in patients over 85 years of age compared to patients aged 85 and younger?
Observational (n=190)
No
Does transcatheter aortic valve replacement (TAVR) have comparable outcomes in patients over 85 years of age compared to patients aged 85 and younger?
Transcatheter aortic valve replacement in selected patients over 85 years of age yields excellent short- and intermediate-term outcomes that are comparable to those in younger patients.
Supports TAVR consideration in selected patients >85 years; leaves open selection bias and need for randomized data.
INTRODUCTION: The Dutch general population is aging rapidly. Many of these patient are fit and eligible for TAVR. However, studies on outcome in older versus younger patients are scant. MATERIAL AND METHODS: A single-centre retrospective study comparing patients older and younger than age 85 on outcome. RESULTS: 190 patients underwent TAVR: 136 were aged 85 or younger (U85), 54 were older than 85 (O85). The U85 group had more men (U85: 71 [52.2%] vs O85: 19 [35.2%]; p = 0.034), a higher incidence of diabetes (U85: 36 [26.5%] vs O85: 3 [5.6%]; p = 0.001) and atrial fibrillation (U85: 35 [25.7%] vs O85: 5 [9.3%]; p = 0.03) and a higher body mass index (U85: 27.5 [± 5.24] vs O85: 26 [± 3.78]; p = 0.027). In the O85 group there was a lower estimated glomerular filtration rate (O85: 50.28 [± 15.32] ml/min vs U85: 65.25 [± 29.97] ml/min; p = 0.012). There was no difference in 30-day mortality (U85: 6 [4.4%] vs O85: 3 [5.6%]) and 1‑year mortality (U85 9 [6.6%] vs O85 3 [5.6%]) (p = 0.521). There was an equal amount of new onset permanent left bundle branch block (U85: 38 [27.9%] vs O85: 14 [25.9%]; p = 0.896) and permanent pacemaker implantation (U85: 28 [20.6%] vs O85: 28 [20.6%]; p = 0.748). There was no difference in bleeding events (p = 0.469), vascular complications (p = 0.195) or moderate/severe regurgitation (p = 0.972). The U85 group had a slightly longer admission duration (U85 6.29 [± 5.289] days vs O85 5.98 [± 3.328] days (p = 0.037)). CONCLUSION: TAVR in patients over 85 years of age has excellent outcome, comparable to those aged 85 and younger.
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Brink et al. (2022) conducted an observational in Aortic valve stenosis (n=190). Age > 85 years vs. Age ≤ 85 years was evaluated on 1-year mortality (p=0.521). In patients undergoing transcatheter aortic valve replacement, there was no significant difference in 1-year mortality between those over 85 years of age and those aged 85 and younger (5.6% vs 6.6%, p=0.521).
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