Key result
TAVR in nonagenarians is well tolerated, yielding ~23% 1-year mortality.
Why the study?
The increasing number of nonagenarians with severe aortic stenosis who may be candidates for TAVR requires understanding of their procedural risks and benefits.
TAVR is a viable option for nonagenarians with severe aortic stenosis, emphasizing the importance of frailty assessment and shared decision-making over chronological age.
TAVR may be reasonable in selected nonagenarians; leaves open prospective validation of selection and outcomes.
As the population ages, clinicians will encounter a growing number of nonagenarians suffering from severe aortic stenosis who may be candidates for transcatheter aortic valve replacement (TAVR). By virtue of a healthy survivor effect or a referral bias, these patients may paradoxically have greater resilience and fewer comorbidities than their octogenarian counterparts. They tend to, on average, tolerate the TAVR procedure quite well with low in-hospital and 1-year mortality rates of 5.5% and 23%, respectively. Appropriate patient selection should consider individualized estimates of procedural risk, potential for functional recovery and for improved quantity and quality of life. Frailty is much more revealing than chronological age, and it can be measured by brief tools such as the Essential Frailty Toolset. Ultimately, the process of shared decision-making is paramount to ensure that the course of action is patient-centered and balances the procedure's expected risks and benefits with the nonagenarian's preferences and values.
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Galatas et al. (2019) conducted a review in severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) was evaluated on 1-year mortality. Transcatheter aortic valve replacement in nonagenarians is generally well tolerated, with average in-hospital and 1-year mortality rates of 5.5% and 23%, respectively.