Outcomes following transcatheter aortic valve replacement for aortic stenosis in patients of extreme age: Analysis from a rural population

Introduction: Previous single- and multi-center studies done in predominantly metropolitan areas have shown transcatheter aortic valve replacement (TAVR) to be a safe and effective treatment modality for patients of advanced age with severe aortic stenosis. However, it is unknown whether similar patient cohorts from rural areas have similar outcomes or if these initial studies are not representative of the experience in more rural areas. Setting: This is a single-center health-care system in a predominantly rural area. Methods: A retrospective chart review case–control study of 339 consecutive patients who underwent a TAVR for severe aortic stenosis at Sanford Health in Fargo, ND, was performed to determine if advanced age (>80 years of age) at the time of TAVR affects short- and long-term outcomes. Results: Despite higher predicted baseline surgical risk,s predominantly rural patients of advanced age had no significant difference in overall survival at 1-month (93% vs. 97%, P = 0.228), 6-month (88% vs. 90%, P = 0.695), 1-year (79% vs. 82%, P = 0.611), or 2-year (63% vs. 60%, P = 0.731) post-TAVR versus younger patients from the same geographical area. Patients of advanced age also had no significant difference in periprocedural or echocardiographic outcomes out to 1-year post-TAVR. Conclusion: This study from a predominantly rural area gives evidence to suggest that there is no association between extreme age (>80 years of age) and decreased overall survival. In addition, high baseline Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation predicted risk was not suggestive of worse outcomes in patients of advanced age. This study gives reassurance of the safety of TAVR in patients of advanced age in rural areas.