Key result
TAVI linked to ~76% lower mortality vs. conservative management in nonagenarians with severe AS.
Why the study?
The comparative clinical outcomes of TAVI versus conservative treatment in nonagenarian patients with symptomatic severe aortic stenosis were unclear.
Does TAVI improve survival and reduce heart failure hospitalization in nonagenarian patients with symptomatic severe aortic stenosis compared to conservative treatment?
Cohort (n=16,848)
Does TAVI improve survival and reduce heart failure hospitalization in nonagenarian patients with symptomatic severe aortic stenosis compared to conservative treatment?
Hazard Ratio: 0.24 (95% CI 0.15–0.37)
Absolute Event Rate: 76% vs 37.7%
TAVI is associated with significantly improved survival and reduced heart failure hospitalizations in nonagenarian patients with severe symptomatic aortic stenosis compared to conservative management.
May support TAVI consideration in selected nonagenarians; extends observational data but remains hypothesis-generating pending RCTs.
PURPOSE: To compare the overall survival and the risk of all-cause and heart failure-specific hospitalization in nonagenarian patients hospitalized for symptomatic severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) or conservative treatment. METHODS: Population-based retrospective cohort study based on healthcare utilization databases of the Italian region of Lombardy. The cohort included all nonagenarians hospitalized for AS between 2017 and 2021, who underwent TAVI within 90 days from first diagnosis or conservative treatment. The association between TAVI and clinical outcomes was assessed through Cox or Fine&Grey regression models. High-dimensional propensity score matching was used to reduce the heterogeneity between groups. RESULTS: Overall, 16,848 nonagenarians hospitalized for AS were identified. Among these, 320 patients underwent TAVI, of which 193 were matched to as many control patients. The 2-year survival rates were 76.0 % and 37.7 %, respectively, in TAVI and control patients, corresponding to an HR of 0.24 (95 % CI 0.15-0.37). The 2-year cumulative incidence of rehospitalization for heart failure was 11.1 % and 26.5 %, respectively, corresponding to an HR of 0.64 (95 % CI 0.40-0.99). CONCLUSIONS: This study further supports the usefulness of TAVI in nonagenarians, as it showed to improve their survival rate, reduce their risk of rehospitalization, and likely increase their quality of life.
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Franchi et al. (2025) conducted a cohort in Symptomatic severe aortic stenosis (n=16,848). Transcatheter aortic valve implantation (TAVI) vs. Conservative treatment was evaluated on Overall survival (HR 0.24, 95% CI 0.15-0.37). TAVI in nonagenarians with severe aortic stenosis was associated with higher 2-year survival compared to conservative treatment (76.0% vs 37.7%; HR 0.24, 95% CI 0.15-0.37).
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