Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients Aged &gt;90 Years Versus &lt;90 Years

Stehli, Julia; Koh, Samuel Ji Quan; Duffy, Stephen J.; Zamani, Jalal; Yeong, C.; Paratz, E.; Martin, Catherine; Htun, N.; Dick, Ron; Walton, Antony

doi:10.1016/j.amjcard.2019.06.026

Cited by 13 publications

(11 citation statements)

References 24 publications

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“…Interestingly, this 1‐year mortality is not drastically different than that of nonagenarians in the general population, which is approximately 15%. In studies comparing patients above and below age 90, the risk of mortality was slightly increased in some studies and no different in others . This inconsistency is at least partially attributable to variable adjustment for age‐related confounders.…”

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 98%

“…Nonagenarians undergoing TAVR are more likely to be women, which is not surprising considering that nonagenarian women outnumber nonagenarian men by 3‐to‐1 in the general population. Nonagenarians undergoing TAVR are less likely to present with comorbid coronary artery disease, peripheral arterial disease, diabetes mellitus, and multiple chronic conditions . These differences can be explained by the healthy survivor effect, the clinician's cognitive bias to be conservative in nonagenarians with significant comorbidities, or a combination of the two.…”

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 99%

“…Frailty has been said to be a better indicator of biological aging and accumulated deficits. Nine studies measured frailty by at least one objective metric such as the Clinical Frailty Scale or the 5‐m gait speed test . Frailty was consistently found to be predictive of mortality and major morbidity after adjusting for comorbid conditions and cardiac status.…”

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 99%

“…Nonagenarians undergoing TAVR are less likely to present with comorbid coronary artery disease, peripheral arterial disease, diabetes mellitus, and multiple chronic conditions. 10,21,24,[27][28][29][30][31][32][33] These differences can be explained by the healthy survivor effect, the clinician's cognitive bias to be conservative in nonagenarians with significant comorbidities, or a combination of the two.…”

Section: T a B L E 1 Reviewed Studiesmentioning

confidence: 99%

“…In studies comparing patients above and below age 90, the risk of mortality was slightly increased in some studies and no different in others. 10,19,21,24,[27][28][29][30]32,33,[38][39][40] This inconsistency is at least partially attributable to variable adjustment for age-related confounders.…”

Section: T a B L E 1 Reviewed Studiesmentioning

confidence: 99%

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Transcatheter aortic valve replacement over age 90: Risks vs benefits

Galatas

Afilalo

2019

Clinical Cardiology

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As the population ages, clinicians will encounter a growing number of nonagenarians suffering from severe aortic stenosis who may be candidates for transcatheter aortic valve replacement (TAVR). By virtue of a healthy survivor effect or a referral bias, these patients may paradoxically have greater resilience and fewer comorbidities than their octogenarian counterparts. They tend to, on average, tolerate the TAVR procedure quite well with low in‐hospital and 1‐year mortality rates of 5.5% and 23%, respectively. Appropriate patient selection should consider individualized estimates of procedural risk, potential for functional recovery and for improved quantity and quality of life. Frailty is much more revealing than chronological age, and it can be measured by brief tools such as the Essential Frailty Toolset. Ultimately, the process of shared decision‐making is paramount to ensure that the course of action is patient‐centered and balances the procedure's expected risks and benefits with the nonagenarian's preferences and values.

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Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 98%

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 99%

Section: Transcatheter Aortic Valve Replacement In Nonagenariansmentioning

confidence: 99%