Long Term Survival and Quality of Life Following Transcatheter Aortic Valve Replacement in Nonagenarians

• Published in: The American journal of cardiology Vol. 213; pp. 140 - 145
• Main Authors: Madanat, Luai, Allam, Mohamed, Khalili, Houman, Rabah, Andrew, Tariq, Rehan, Zamzam, Mazen, Rodés-Cabau, Josep, Pilgrim, Thomas, Okuno, Taishi, Elmariah, Sammy, Pibarot, Philippe, Abbas, Amr E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 15-02-2024
• Subjects: Aorta; Aortic stenosis; Aortic valve; Cardiomyopathy; Cardiovascular disease; Heart; Heart valves; Hospitals; Kidney diseases; Morbidity; Mortality; Mortality risk; Quality of life; Statistical analysis; Statistical models; Survival; Survival analysis; Thorax; Minnesota; California; Florida; United States > US; Massachusetts; long term mortality; KCCQ score; quality of life; NYHA score; TAVR; Nonagenarians
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2023.12.031

Transcatheter aortic valve replacement (TAVR) has emerged as a successful treatment option for severe aortic stenosis (AS). However, the long term outcomes of TAVR in nonagenarians is lacking. We aimed to examine the long-term mortality and quality-of-life in nonagenarians after TAVR. This is a multi-center retrospective analysis on patients with severe AS undergoing TAVR. Patients were divided into two groups: Nonagenarians (age ≥ 90 years) and age < 90 years. Kansas city cardiomyopathy questionnaires (KCCQ) and New York Heart Associated (NYHA) scores were compared pre- and post-TAVR. All-cause mortality was compared between both groups at 30 days, 1-year and 5-years post-TAVR using Cox-proportional hazard model. A total of 6896 patients were included, of which 591 were nonagenarians. Nonagenarians had a higher STS perioperative risk of mortality (8.1 ± 4.6% vs 5.4 ± 4.2%, p<0.001) pre-TAVR. Both groups were similar in baseline KCCQ and NYHA scores. At one year post-TAVR, there was no significant difference in improvement in the KCCQ overall score between age < 90 and nonagenarians (-4.76, 95% CI: -11.4 - 1.9, p = 0.161). Similarly, there was no statistically significant difference in improvement in NYHA class between the two groups at 1-year (OR: 1.07, 95% CI: 0.85 - 1.25), p = 0.526). The unadjusted 30-day (3.2% vs 2.7%; HR:1.11, 95% CI: 0.70-1.80, p=0.667) and 5-year (28.0% vs 26.6%, HR: 1.05, 95% CI:0.89-1.24, p=0.60) all-cause mortality were similar between the two groups. In conclusion, this study demonstrates an excellent long-term mortality rate at 5 years following TAVR in nonagenarians, comparable to patients younger than 90 years old. There is a significant and enduring improvement in functional status in nonagenarians, observed up to 1 year following TAVR.