Publication: Transfemoral TAVR in Nonagenarians: From the CENTER Collaboration.
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Identifiers
Date
2019-02-19
Authors
Vlastra, Wieneke
Chandrasekhar, Jaya
Vendrik, Jeroen
Gutierrez-Ibanes, Enrique
Tchetche, Didier
de Brito, Fabio S
Barbanti, Marco
Kornowski, Ran
Latib, Azeem
D'Onofrio, Augusto
Advisors
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
This study aimed to compare differences in patient characteristics and clinical outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) versus patients younger than 90 years of age and to test the predictive accuracy of the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), the EuroSCORE II, and the STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) for mortality after TAVR in nonagenarians. The prevalence of severe aortic valve stenosis is increasing due to the rising life expectancy. However, there are limited data evaluating outcomes in patients older than 90 years of age. Moreover, the predictive accuracy of risk scores for mortality has not been evaluated in nonagenarian patients undergoing transfemoral TAVR. The CENTER (Cerebrovascular EveNts in Patients Undergoing TranscathetER Aortic Valve Implantation) collaboration (N = 12,381) is an international collaboration consisting of 3 national registries, 6 local or multicenter registries, and 1 prospective clinical study, selected through a systematic online search. The primary endpoint of this study was the difference in 30-day all-cause mortality and stroke after TAVR in nonagenarians versus patients younger than 90 years of age. Secondary endpoints included differences in baseline characteristics, in-hospital outcomes, and the differences in predictive accuracy of the logistic EuroSCORE, the EuroSCORE II, and STS-PROM. A total of 882 nonagenarians and 11,499 patients younger than 90 years of age undergoing transfemoral TAVR between 2007 and 2018 were included. Nonagenarians had considerably fewer comorbidities than their counterparts. Nevertheless, rates of 30-day mortality (9.9% vs. 5.4%; relative risk [RR]: 1.8; 95% confidence interval [CI]: 1.4 to 2.3; p = 0.001), in-hospital stroke (3.0% vs. 1.9%; RR: 1.5; 95% CI: 1.0 to 2.3; p = 0.04), major or life-threatening bleeding (8.1% vs. 5.5%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.004), and new-onset atrial fibrillation (7.9% vs. 5.2%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.01) were higher in nonagenarians. The STS-PROM adequately estimated mortality in nonagenarians, with an observed-expected mortality ratio of 1.0. In this large, global, patient-level analysis, mortality after transfemoral TAVR was 2-fold higher in nonagenarians compared with patients younger than 90 years of age, despite the lower prevalence of baseline comorbidities. Moreover, nonagenarians had a higher risk of in-hospital stroke, major or life-threatening bleeding, and new-onset atrial fibrillation. The STS-PROM was the only surgical risk score that accurately predicted the risk of mortality in nonagenarians.
Description
MeSH Terms
Age factors
Aged
Aged, 80 and over
Aortic valve
Aortic valve stenosis
Catheterization, peripheral
Female
Femoral artery
Hemodynamics
Humans
Male
Postoperative complications
Punctures
Randomized controlled trials as topic
Recovery of function
Registries
Risk assessment
Risk factors
Time factors
Transcatheter aortic valve replacement
Trauma severity indices
Treatment outcome
Aged
Aged, 80 and over
Aortic valve
Aortic valve stenosis
Catheterization, peripheral
Female
Femoral artery
Hemodynamics
Humans
Male
Postoperative complications
Punctures
Randomized controlled trials as topic
Recovery of function
Registries
Risk assessment
Risk factors
Time factors
Transcatheter aortic valve replacement
Trauma severity indices
Treatment outcome
DeCS Terms
Arteria femoral
Cateterismo periférico
Complicaciones posoperatorias
Estenosis de la válvula aórtica
Factores de riesgo
Hemodinámica
Medición de riesgo
Punciones
Cateterismo periférico
Complicaciones posoperatorias
Estenosis de la válvula aórtica
Factores de riesgo
Hemodinámica
Medición de riesgo
Punciones
CIE Terms
Keywords
Centenarians, Nonagenarians, Stroke, Transcatheter aortic valve replacement
Citation
Vlastra W, Chandrasekhar J, Vendrik J, Gutierrez-Ibanes E, Tchétché D, de Brito FS Jr, et al. Transfemoral TAVR in Nonagenarians: From the CENTER Collaboration. JACC Cardiovasc Interv. 2019 May 27;12(10):911-920