Outcomes of Treatment of Nonagenarians With Severe Aortic Stenosis

Mack, Michael; Herbert, Morley A.; Akram, Siddique; Kim, Rebeca; Prince, Brandon A.; Harrington, Katherine; Holper, Elizabeth M.

doi:10.1016/s0735-1097(14)61938-0

Cited by 8 publications

(18 citation statements)

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“…Consistent with the findings from our larger study, both studies showed a comparable incidence of in‐hospital mortality in both groups. However, the study by Mack et al showed that the in‐hospital mortality rate with TAVR was ~10%, which is higher than the incidence of in‐hospital mortality seen in our study (~6.6%). The patients in that study had more co‐morbidities than our cohort (e.g., coronary artery disease, prior myocardial infarction, prior coronary artery bypass grafting, peripheral vascular disease), which might explain the higher in‐hospital mortality noted in that study, and also indicates that nonagenarians who undergo TAVR or SAVR in clinical practice are a highly selected cohort.…”

Section: Discussioncontrasting

confidence: 90%

“…However, the study by Mack et al showed that the in‐hospital mortality rate with TAVR was ~10%, which is higher than the incidence of in‐hospital mortality seen in our study (~6.6%). The patients in that study had more co‐morbidities than our cohort (e.g., coronary artery disease, prior myocardial infarction, prior coronary artery bypass grafting, peripheral vascular disease), which might explain the higher in‐hospital mortality noted in that study, and also indicates that nonagenarians who undergo TAVR or SAVR in clinical practice are a highly selected cohort. Similar to our study, Mack et al showed that those who underwent TAVR were more likely to be discharged home, which suggests that TAVR might be associated with less morbidity.…”

Section: Discussioncontrasting

confidence: 90%

“…Only few small studies have attempted to compare TAVR versus SAVR in nonagenarians; however, these studies were single/two center experiences with small cohorts (59 nonagenarians in one study, and 110 in the other) . Consistent with the findings from our larger study, both studies showed a comparable incidence of in‐hospital mortality in both groups.…”

Section: Discussionsupporting

confidence: 81%

“…The patients in that study had more co‐morbidities than our cohort (e.g., coronary artery disease, prior myocardial infarction, prior coronary artery bypass grafting, peripheral vascular disease), which might explain the higher in‐hospital mortality noted in that study, and also indicates that nonagenarians who undergo TAVR or SAVR in clinical practice are a highly selected cohort. Similar to our study, Mack et al showed that those who underwent TAVR were more likely to be discharged home, which suggests that TAVR might be associated with less morbidity. Our study also showed that TAVR was associated with fewer in‐hospital complications such as acute kidney injury, which has been linked to worse outcomes .…”

Section: Discussionmentioning

confidence: 81%

“…A recent analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry showed that the 30‐day and 1‐year mortality after TAVR in nonagenarians are only modestly elevated compared to younger patients . However, only few small studies have assessed the comparative efficacy and safety of TAVR versus SAVR among nonagenarians . With the projected growth of the very elderly population in the US, it is important to better understand the comparative outcomes of TAVR versus SAVR in this population.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Elgendy

Mahmoud

Elbadawi

et al. 2018

Cathet Cardio Intervent

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Objectives To compare the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in nonagenarians. Background Data comparing the outcomes of TAVR versus SAVR in nonagenarians are limited. Methods Using the National Inpatient Sample years 2012–2014, hospitalization data were retrieved for subjects aged ≥90 years who underwent TAVR or SAVR for severe aortic stenosis. The incidence of in‐hospital mortality and peri‐procedural outcomes were compared using unadjusted, multivariate logistic regression, and propensity score matched analyses. Results The final cohort included 6,680 records of nonagenarians undergoing aortic valve replacement, among which 5,840 (87.4%) underwent TAVR. There was no difference in the incidence of in‐hospital mortality between both groups in the unadjusted (5.8% versus 6.0% P = 0.95), multivariate (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35–1.74), and propensity score matched (OR 1.07, 95% CI 0.75–1.51) analyses. In the propensity‐matched analysis, TAVR was associated with a lower incidence of acute kidney injury (OR 0.58, 95% CI 0.47–0.72), post‐operative blood transfusion (OR 0.51, 95% CI 0.43–0.61), a higher likelihood of discharge to home (OR 4.71, 95% 3.44–5.06), and a similar incidence of pacemaker placement (OR 1.16, 95% 0.89–1.53) and stroke (OR 1.34, 0.90–1.99). Conclusions In this nationwide analysis, TAVR was associated with an overall similar incidence of in‐hospital mortality and less morbidity compared with SAVR. These findings suggest that TAVR is effective and safe in nonagenarians.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussioncontrasting

confidence: 90%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Elgendy

Mahmoud

Elbadawi

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY)

et al. 2020

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Predictors of survival, functional survival, and hospital readmission in octogenarians after surgical aortic valve replacement

Kuo

Shah

Hiebert

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objective: To analyze outcomes and predictors of functional survival (personal care home admission and mortality) and hospital readmission in patients aged 80 years who underwent surgical aortic valve replacement (SAVR) in a Manitoba hospital.Methods: This was a retrospective cohort study of patients aged 80 years who underwent SAVR with or without coronary artery bypass grafting in Manitoba between 1995 and 2014. Data from the Manitoba Adult Cardiac Surgery database and the Manitoba Centre for Health Policy were used. Kaplan-Meier estimates of outcomes and Cox multivariate regression analysis of risk factors were performed. Survival was compared with that of age-and sex-matched life expectancy.Results: A total of 1872 patients were aged 50 years and 378 were aged 80 years, 55% of whom (n ¼ 208) underwent concurrent coronary artery bypass grafting. Compared with younger patients, octogenarians had higher in-hospital mortality (8.5%; P <.001), longer median intensive care unit stay (47.2 hours; P <.001), and longer median in-hospital stay (13 days; P <.001). The median follow-up was 5.2 years. Functional survival was 82.4% at 1 year and 56.5% at 5 years, and freedom from hospital readmission was 61.5% at 1 year and 28.4% at 5 years. Survival approximated the age-and sex-matched life expectancy at 1 year (83.8%) and 5 years (60.8%). Preoperative atrial fibrillation, peripheral vascular disease, female sex, postoperative acute kidney injury, and blood transfusion were associated with adverse outcomes. Conclusions:In eligible octogenarians, SAVR has acceptable 1-and 5-year functional survival and hospital readmission rates, but significant perioperative mortality and morbidity.

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Outcomes of Treatment of Nonagenarians With Severe Aortic Stenosis

Cited by 8 publications

References 0 publications

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY)

Predictors of survival, functional survival, and hospital readmission in octogenarians after surgical aortic valve replacement

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