Risk of Bleeding in Elderly Patients Undergoing Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement

Abstract

Background: Bleeding complications are strong predictors of mortality and major morbidity in elderly patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Despite the high prevalence of frailty in this population, little is known about its effects on bleeding risk. Methods: We conducted a retrospective observational study of 502 patients undergoing isolated SAVR or TAVI between January 2015 and February 2022. The occurrence of blood products transfusions and MACEs were the primary endpoints. In-hospital mortality was the secondary endpoint. Results: The Elderly group (age < 80 years old) included 475 subjects, whereas the Very Elderly group (age ≥ 80 years old) included 127 patients. The need for blood product transfusion was similar among the two groups, regardless of the type of procedure. MACEs occurred similarly between groups [SAVR: Elderly group: 7.9% vs. Very Elderly group: 8.6%, p = 0.864; TAVI: Elderly group: 5.5% vs. Very Elderly group: 8.7%, p = 0.378]. The was no difference in in-hospital mortality rate in patients submitted to TAVI, whereas very elderly patients had higher mortality rate compared to the elderly patients submitted to SAVR [SAVR: Elderly group: 0% vs. Very Elderly group: 2.8%, p = 0.024; TAVI: Elderly group: 4,8% vs. Very Elderly group: 8%, p = 0.389]. Conclusions: Age alone should not be considered as a predictive factor for post-operative adverse events or in-hospital mortality in elderly patients with severe symptomatic AS.

The Outcomes for Different Biological Heart Valve Prostheses in Surgical Aortic Valve Replacement before and after the Introduction of Transcatheter Aortic Valve Implantation

“…A very recent report indicated that, even in octogenarian patients, a 5-year survival rate of over 60% could be reached for patients who left the hospital alive [9]. It also confirmed our early view that age in itself is not the only determinant of postoperative mortality [8]. Another of our older reports also indicated that the age and comorbidity of the referred patients increased in the period between 1987 and 2007 [10], until the introduction of TAVI.…”

“…In one series, comparing SAVR and TAVI for two age groups, septuagenarians and octogenarians, the CEME device was used throughout for the SAVR, while the successive Sapien devices were used for the TAVI group. The investigated patients were very similar to the current group with respect to age, but coronary artery disease and the association of a CABG or any other procedure were seemingly absent [8]. A very recent report indicated that, even in octogenarian patients, a 5-year survival rate of over 60% could be reached for patients who left the hospital alive [9].…”