Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: severe aortic stenosis (n=60). Intervention: Transcatheter aortic valve implantation (TAVI). Primary outcome: Kaplan-Meier estimated 5-year all-cause survival (95% CI 23%-47%).

Q: What does this research mean for the field?

In selected nonagenarians undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis, 5-year survival is 35% with high procedural success and acceptable short-term safety. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Gianluca Pagnoni; Marco Loffi; Dalia Caleffi; Susan Darroudi; Giuseppe Masaracchia; Benedetta Frassoni; Francesco Marangi; Sophia di Michele; Davide Gabbieri; Luciano Losi; Alberto Monello; Fabio Alfredo Sgura; Salvatore Arrotti; Rosario Rossi; Daniele Iaccarino; Marco Ruozzi; Vincenzo Guiducci; Filippo Luca Gurgoglione; Giorgio Benatti; Luigi Vignali; Giampaolo Niccoli; Giuseppe Boriani; Daniela Aschieri; Francesca Coppi

doi:10.3389/fcvm.2026.1945453

Key result

TAVI yields ~35% 5-year survival in selected nonagenarians with severe aortic stenosis.

95% CI 23%-47%
n=60

Why the study?

Data on long-term outcomes after TAVI in nonagenarian patients with severe aortic stenosis remain limited.

Does transcatheter aortic valve implantation (TAVI) provide acceptable long-term survival and procedural safety in nonagenarian patients (aged ≥90 years) with symptomatic severe aortic stenosis?

Key Points

To evaluate long-term survival and procedural outcomes of transcatheter aortic valve implantation (TAVI) in nonagenarians and explore clinical factors associated with long-term mortality.
Ambispective multicenter observational cohort study of 60 consecutive patients aged ≥90 years (mean age 91 ± 1.5 years; 67% female) treated between 2013 and 2021 across six centers in Emilia-Romagna, Italy.
Retrospectively collected baseline and procedural data with vital-status follow-up over a mean observation period of 5.7 years, evaluated via the Kaplan–Meier method and exploratory multivariable Cox regression.
Procedural success was achieved in 97% of cases, with in-hospital mortality at 5% and cumulative 30-day mortality at 8.3%.
Kaplan–Meier estimated survival probabilities were 85% (95% CI, 76%–94%) at 1 year, 65% (95% CI, 53%–77%) at 3 years, and 35% (95% CI, 23%–47%) at 5 years.
In exploratory multivariable analysis, higher long-term mortality was associated with male sex (HR, 2.5; 95% CI, 1.2–5.0; p = 0.02) and chronic obstructive pulmonary disease (HR, 2.9; 95% CI, 1.2–7.2; p = 0.02).

Study Design

Type

Cohort (n=60)

Multicenter

Yes

Structured PICO

Does transcatheter aortic valve implantation (TAVI) provide acceptable long-term survival and procedural safety in nonagenarian patients (aged ≥90 years) with symptomatic severe aortic stenosis?

P

Population

60 nonagenarian patients (mean age 91 years, 67% female) with severe symptomatic aortic stenosis who underwent TAVI and were followed for a mean of 5.7 years.

E

Exposure

Transcatheter aortic valve implantation (TAVI) performed according to each center's standard practice, using either balloon-expandable (53%) or self-expandable (47%) prostheses, predominantly via transfemoral access (92%).

O

Outcome

Kaplan–Meier estimated probability of all-cause survival at 5 years after TAVIhard clinical

In carefully selected nonagenarians with severe symptomatic aortic stenosis, TAVI is a highly successful procedure associated with acceptable safety and a clinically meaningful 35% estimated survival at 5 years.

Limitations

Lack of an untreated control group or direct comparison with an age- and sex-matched general population.
Small sample size and potential selection bias.
Retrospective ascertainment of some outcomes without standardized longitudinal measures of functional status, frailty, or quality of life.
Causes of long-term death were not systematically adjudicated.
The cohort predominantly represented younger nonagenarians (mean age 91), limiting extrapolation to patients aged 95 years or older.
Did not include a harmonized cross-center selection protocol, so candidate-selection thresholds may have varied
Registry did not systematically capture all components required for formal VARC-2 device-success endpoint
Did not include an untreated control group
Cardiovascular and non-cardiovascular mortality could not be analyzed reliably
Small cohort size with potential selection bias

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Implication

Supports TAVI feasibility in selected nonagenarians; leaves open randomized evaluation of survival benefit versus medical management.

Abstract

Background The growing number of nonagenarian patients with severe aortic stenosis has increased interest in transcatheter aortic valve implantation (TAVI) in this population. However, data on long-term outcomes remain limited. This study aimed to evaluate long-term survival and procedural outcomes of TAVI in nonagenarians and to explore clinical factors associated with long-term mortality. Methods We conducted an ambispective multicenter observational cohort study including patients aged ≥90 years who underwent TAVI for severe aortic stenosis between 2013 and 2021 at six centers in the Emilia-Romagna region, Italy. Baseline and procedural data were collected retrospectively, while outcome ascertainment combined prospective follow-up contacts with retrospective verification of dates of death or last confirmed vital status. Survival was estimated using the Kaplan–Meier method, and associations with mortality were examined using an exploratory Cox regression analysis. Results A total of 60 nonagenarian patients (mean age 91 ± 1.5 years; 67% female) were included. Procedural success was achieved in 97% of cases. In-hospital mortality was 5%, and 30-day mortality was 8.3%. Over a mean observation period of 5.7 years from TAVI to death or the last confirmed vital-status assessment, the Kaplan–Meier estimated 5-year survival was 35%. In the exploratory multivariable analysis, male sex and chronic obstructive pulmonary disease (COPD) were associated with higher long-term mortality. Conclusions In patients aged ≥90 years selected by the Heart Team for TAVI, the Kaplan–Meier estimated 5-year survival was 35%. The procedure demonstrated a high success rate and an acceptable safety profile. Male sex and COPD showed an exploratory association with worse prognosis. These findings suggest that TAVI may be a feasible option in carefully selected nonagenarians when guided by comprehensive clinical assessment and individualized decision-making.

Discussion

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Cite This Study

Pagnoni et al. (2026) conducted a cohort in severe aortic stenosis (n=60). Transcatheter aortic valve implantation (TAVI) was evaluated on Kaplan-Meier estimated 5-year all-cause survival (95% CI 23%-47%). In carefully selected nonagenarian patients with severe aortic stenosis undergoing transcatheter aortic valve implantation, the Kaplan-Meier estimated 5-year overall survival was 35%.

synapsesocial.com/papers/6acc29b9005c34d980820f1d https://doi.org/10.3389/fcvm.2026.1945453

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Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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