ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2017 February;58(1):99-104

DOI: 10.23736/S0021-9509.16.09038-8

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Short- and mid-term results after transapical transcatheter aortic valve replacement in nonagenarians

Andreas R. DE BIASI ¹, S. Chiu WONG ², Robert M. MINUTELLO ², Konstantinos VOUDRIS ², Berhane WORKU ¹, Leonard N. GIRARDI ¹, Arash SALEMI 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

BACKGROUND: 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.
CONCLUSIONS: 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.

KEY WORDS: Transcatheter aortic valve replacement - Aortic valve stenosis - Aged, 80 and over