Nonagenarians in CARDELIR - the 10-year survivors after aortic valve replacement

Abstract Background Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) improve survival and quality of life in older patients with severe aortic stenosis (AS). However, in the scientific literature, characteristics of the 10-year survivors in the oldest group of patients undergoing surgery are sparsely described. Purpose To describe the clinical and demographic baseline characteristics of the nonagenarian survivors 10 years after aortic valve replacement. Methods A longitudinal prospective cohort study of patients with severe AS receiving SAVR or TAVI was performed in a tertiary Norwegian university hospital. Inclusion criteria: ≥ 80 years, previously accepted for SAVR or TAVI, able to speak and understand Norwegian, and provide written consent to participate. Clinical and demographic data were identified from medical records. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI), and surgical cardiac risk with the Logistic EuroSCORE I. Self-reports from the Study of Osteoporotic Fractures (SOF) frailty index. The Barthel Index (ADL), the Nottingham scale (IADL), and hospital anxiety and depression scale (HADS). Hospital information registries provided information regarding vital status. Results A total of 143 patients were included. Mean age of the total cohort at the time of surgery (baseline) was 83.5+ 2.7 years, (57% women, 55% SAVR and 45% TAVI), and 34% were robust, 27% prefrail, and 39% frail. At 10-year follow- up, 38 (27%), now nonagenarians, were still alive (mean age 92.7 years, range 90-99 years, 68% women, 74% SAVR and 26% TAVI). Baseline socio-demographic characteristics of the 10-year survivors were as follows; 50% were widow/widowers and lived alone, 74% had basic education,18% high school, and 8% bachelor or higher education. Baseline clinical characteristics were as follows; 47% were in NYHA class III. Logistic EuroSCORE I was 11.8+ 6.2, and CCI was 1.7, 95% had LVEF 50, mean aortic valve area 0.4 cm2, while mean aortic valve gradient was 52 mmHg. As for baseline self-report, 53% were robust, 32% were prefrail, and 16% were frail. Mean Barthel index 19.4+1.1, HADS anxiety score was 4.5 +1.1, HADS depression score was 2.9 +2.1. Mean IADL was 57.9+ 8.3. Number of readmissions at 10-year post-surgery was mean 7.2 (range 1-37). Conclusion As expected, the survivors had reduced physical functioning before treatment, including reduced independence in activities of daily living. The number of readmissions varied greatly during the 10-year follow-up time. However, typical for the survivors - now reached the age of 90+ - was good mental health at baseline. They were also considered robust or prefrail with a low CCI score before treatment. Further work on post-treatment status at 6 months is currently being conducted.