RT Journal Article
T1 Transfemoral TAVR in Nonagenarians: From the CENTER Collaboration.
A1 Vlastra, Wieneke
A1 Chandrasekhar, Jaya
A1 Vendrik, Jeroen
A1 Gutierrez-Ibanes, Enrique
A1 Tchetche, Didier
A1 de Brito, Fabio S
A1 Barbanti, Marco
A1 Kornowski, Ran
A1 Latib, Azeem
A1 D'Onofrio, Augusto
A1 Ribichini, Flavio
A1 Baan, Jan
A1 Tijssen, Jan G P
A1 Pan, Manuel
A1 Dumonteil, Nicolas
A1 Mangione, Jose A
A1 Sartori, Samantha
A1 D'Errigo, Paola
A1 Tarantini, Giuseppe
A1 Lunardi, Mattia
A1 Orvin, Katia
A1 Pagnesi, Matteo
A1 Sanchez Gila, Joaquin
A1 Modine, Thomas
A1 Dangas, George
A1 Mehran, Roxana
A1 Piek, Jan J
A1 Delewi, Ronak
K1 Centenarians
K1 Nonagenarians
K1 Stroke
K1 Transcatheter aortic valve replacement
AB 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.
PB Elsevier
YR 2019
FD 2019-02-19
LK http://hdl.handle.net/10668/14007
UL http://hdl.handle.net/10668/14007
LA en
NO 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
DS RISalud
RD Apr 6, 2025