Clinical outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Noguchi, Masahiko; Ueyama, Hiroki; Ando, Tomo; Takagi, Hisato; Kuno, Toshiki

doi:10.1007/s12928-021-00755-w

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…There is a growing general tendency to progressively involve nonagenarian patients in standard treatments across different specialties such as cardiology, 16,17 neurology 18,19 and orthopedic surgery 20 . Published evidence globally supports that age alone must not be a limitation for intervention 21 . However, the life prognosis of these patients is reduced and this issue has to be considered on a case‐by‐case basis 22 .…”

Section: Discussionmentioning

confidence: 99%

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Acute limb ischemia in nonagenarians: Characteristics and factors related to outcomes in a single‐center consecutive series

Casajuana Urgell,

Calsina Juscafresa,

Mascaró Oliver

et al. 2023

World j. surg.

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BackgroundThe increasing aging and frailty of the population make the management of acute limb ischemia (ALI) more difficult, with decision‐making far from being guided by evidence. The aim of the study was to evaluate the characteristics and results of ALI treatment in nonagenarians.Materials and MethodsRetrospective analysis of a consecutive series of nonagenarian patients with ALI attended at our institution between 2008 and 2021. The primary outcomes of the study were 1‐year limb salvage and survival rates.ResultsA total of 102 patients were included (mean age 92.38, 78.4% women). In 83 cases (81.4%) ALI was attributed to embolism, and 19 (18.6%) to acute arterial thrombosis. One‐month overall survival was 70.6%. Fifteen patients (14.7%) were treated palliatively, including 8 (53.3%) irreversible ALI with associated malignancy/advanced dementia, 5 (33.3%) with associated cerebral/intestinal ischemia and 2 (13.3%) with aortic occlusion and poor medical condition. None of these patients survived after 10 days. The remaining 87 patients (85.3%) were treated with isolated anticoagulation (n = 8, 9.1%), primary major amputation (n = 1, 1.1%) or revascularization (n = 78, 89.6%), including 69 (67.6%) embolectomies, 6 (5.9%) bypass and 3 (2.9%) endovascular techniques. One‐year limb salvage and survival rates were 96% and 48%, respectively. Predictive factors of lower survival included anemia (HR = 1.81, p = 0.014) and ALI severity (HR = 1.73, p = 0.032), but not cognitive or functional status. Patients surviving the ALI episode had a 1‐year survival rate significantly below that of a similar matched population.ConclusionAlthough nonagenarians with an ALI are often functionally and cognitively impaired and have a limited life expectancy, most patients need revascularization for limb salvage and this can be done successfully with a low invasive surgery.

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Section: Discussionmentioning

confidence: 99%

“…20 Published evidence globally supports that age alone must not be a limitation for intervention. 21 However, the life prognosis of these patients is reduced and this issue has to be considered on a case-by-case basis. 22 ALI should not be an exception.…”

Section: Non-palliative Patients (Nmentioning

confidence: 99%

Acute limb ischemia in nonagenarians: Characteristics and factors related to outcomes in a single‐center consecutive series

Casajuana Urgell,

Calsina Juscafresa,

Mascaró Oliver

et al. 2023

World j. surg.

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“…Although mortality is significantly higher in these patients, most probably due to the intrinsic higher risk profile of the very old patients, the results are still acceptable [53]. Moreover, an association between previous severe renal dysfunction and frailty may significantly predict mid-term mortality after TAVI in nonagenarians [54]. Deharo et al described that among nonagenarians with AS, patients treated with TAVI had a lower risk of cardiovascular events than matched medically treated patients [16].…”

Section: Tavi In Nonagenariansmentioning

confidence: 99%

“…A literature review that identified 16 observational studies found that nonagenarians exhibited significantly higher rates of short-term mortality (hazard ratio [HR], 95% confidence interval [CI]: 1.48, 1.38-1.59; p < 0.001) and long-term mortality (HR, 95% CI: 1.34, 1.24-1.44; p < 0.001) compared to their younger counterparts following TAVI [54]. Importantly, complications were observed among nonagenarians who underwent TAVI.…”

Section: Tavi In Nonagenariansmentioning

confidence: 99%

Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation

Khawaja

Virk

Bandyopadhyay

et al. 2023

JCDD

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Patients with a clinical indication for aortic valve replacement can either undergo surgical aortic valve replacement (SAVR) or Transcatheter Aortic Valve Implantation (TAVI). There are many different factors that go into determining which type of replacement to undergo, including age, life expectancy, comorbidities, frailty, and patient preference. While both options offer significant benefits to patients in terms of clinical outcomes and quality of life, there is growing interest in expanding the indications for TAVI due to its minimally invasive approach. However, it is worth noting that there are several discrepancies in TAVI outcomes in regards to various endpoints, including death, stroke, and major cardiovascular events. It is unclear why these discrepancies exist, but potential explanations include the diversity of etiologies for aortic stenosis, complex patient comorbidities, and ongoing advancements in both medical therapies and devices. Of these possibilities, we propose that phenotypic variation of aortic stenosis has the most significant impact on post-TAVI clinical outcomes. Such variability in phenotypes is often due to a complex interplay between underlying comorbidities and environmental and inherent patient risk factors. However, there is growing evidence to suggest that patient genetics may also play a role in aortic stenosis pathology. As such, we propose that the selection and management of TAVI patients should emphasize a precision medicine approach.

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Impact of periprocedural bleeding on mid-term outcome in nonagenarians who underwent transcatheter aortic valve implantation: insights from LAPLACE registry

Fukutomi

Onishi

Ando

et al. 2023

J Thromb Thrombolysis

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Clinical outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Cited by 3 publications

References 40 publications

Acute limb ischemia in nonagenarians: Characteristics and factors related to outcomes in a single‐center consecutive series

Acute limb ischemia in nonagenarians: Characteristics and factors related to outcomes in a single‐center consecutive series

Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation

Impact of periprocedural bleeding on mid-term outcome in nonagenarians who underwent transcatheter aortic valve implantation: insights from LAPLACE registry

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