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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
de Biasi A. R. 1, Wong S. C. 2, Minutello R. M. 2, Voudris K. 2, Worku B. 1, Girardi L. N. 1, Salemi A. 1
1 Department of Cardiothoracic Surgery, Weill Cornell Medical College / New York-Presbyterian Hospital, New York, NY, USA;
2 Department of Medicine, Weill Cornell Medical College / New York-Presbyterian Hospital, New York, NY, USA
AIM: Recent reports have suggested that advanced age may preclude favorable outcomes in transcatheter aortic valve replacement (TAVR), particularly when performed via transapical (TA) access. However, detailed examinations of TA-TAVR in nonagenarian patients are lacking in the contemporary literature. We therefore describe our experience with 25 consecutive nonagenarians who underwent TA-TAVR and report their short- and mid-term outcomes.
METHODS: We identified all patients 90 years old or greater who underwent TA-TAVR between 2009-2014 at our institution. Demographic, comorbidity and echocardiographic data were obtained for all patients as were their in-hospital, 30-day, and 1-year outcomes. Overall survival was calculated using the Kaplan-Meier method.
RESULTS: The mean Society of Thoracic Surgeons’ predicted risk of mortality was 10.2 (SD ± 3.4) %. Twenty-four nonagenarians received TA-TAVR secondary to severe aortic stenosis while 1 had a valve-in-valve procedure for a regurgitant bioprosthetic valve. There were no conversions to open surgery, no aborted procedures, and no in-hospital deaths or strokes; 44% of patients (N = 11) were discharged to home. Five patients required cardiac rehospitalization within the first 30 days and 2 experienced strokes during the first year. Overall 30-day and 1- year survival were 100% and 83%, respectively.
CONCLUSION: TA-TAVR can safely be performed on nonagenarians subjected to otherwise standard selection criteria. Chronology should not stand as a routine contraindication to this procedure; rather, comorbidities and functional status should define patient eligibility for TA- TAVR.