Temporal Trends and Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians

Mentias, Amgad; Saad, Marwan; Desai, Milind Y.; Horwitz, Phillip A.; Rossen, James D.; Panaich, Sidakpal; Elbadawi, Ayman; Qazi, Abdul H.; Sorajja, Paul; Jneid, Hani; Kapadia, Samir; London, Barry; Vaughan-Sarrazin, Mary

doi:10.1161/jaha.119.013685

Cited by 19 publications

(18 citation statements)

References 28 publications

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“…With the advances in preprocedural planning of TAVR and iteration of devices with smaller delivery systems, outcomes of TAVR have improved both in the overall population and in high‐risk groups 11,15 . Although our study showed a significant decrease in the crude in‐hospital mortality rate in TAVR on CD, this did not remain significant after adjustments for demographic, hospital characteristics, and procedural years.…”

Section: Discussioncontrasting

confidence: 56%

“…The increased mortality of SAVR in 2017 compared with 2013 even after adjustments despite the decrease in stroke and bleeding is concerning. There were no similar trends of in‐hospital and 30‐days mortality after SAVR in registries from Germany and the United States 15‐18 . Although the exact cause could not be identified by this study, change in patient profile undergoing SAVR may have resulted in sicker SAVR recipients (indicated by higher Elixhauser score) in 2017 compared with 2013.…”

Section: Discussionmentioning

confidence: 70%

“…There were no similar trends of in-hospital and 30-days mortality after SAVR in registries from Germany and the United States. [15][16][17][18] Although the exact cause could not be iden- The analysis of endovascular TAVR in CD versus non-CD suggested that TAVR in CD still had worse outcomes compared with non-CD patients. However, the rate of stroke and bleeding, which both are associated with increased mortality, 18,19 patients on CD for a longer period could have been more prevalent in one group compared with the others.…”

Section: Discussionmentioning

confidence: 99%

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Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

et al. 2020

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Background and Aim: Trends of utilization and outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for patients on chronic dialysis (CD) are not well described. We aimed to assess the trends in utilization and outcomes of TAVR and SAVR on CD. Methods: Nationwide Readmission Databases from 2013 to 2017 was analyzed. International Classification of Diseases Clinical Modification 9 and 10 codes were used to identify diagnoses and procedures. A multivariable regression model was used to compare the outcomes expressed as adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: A total of 5731 TAVR and 6491 SAVR were performed in patients with CD, respectively. The volume of TAVR increased by approximately four-folds and SAVR increased by approximately 33%. However, amongst patients with CD, the percentage of TAVR increased, whereas that of SAVR decreased (p < .001 for all). In 2016 and 2017, TAVR volume surpassed that of SAVR on CD. In-hospital mortality remained similar in TAVR (aOR: 0.92; 95% CI: 0.79-1.07; p-trend = .23) whereas it increased significantly in SAVR (aOR: 1.14: 95% CI: 1.05-1.25, p-trend = .002). In 2017, in-hospital mortality and 30-day readmission were significantly higher in TAVR among CD than non-CD patients. Conclusion: Despite increased use of TAVR among CD, there still is an opportunity for improvement in outcome of aortic valve replacement for those on CD.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

et al. 2020

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“…Irrespective of the indication for admission, studies have shown increased in-hospital complication rates associated with older age resulting in worse outcomes (11). TAVR is a relatively safe procedure even in nonagenarians (12). Multiple studies have been performed comparing TAVR to SAVR in the older population.…”

Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital mortality and clinical outcomes among patients greater than and less than 80 years undergoing TAVR

Murthi

Velagapudi

Sharma

et al. 2022

Preprint

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Introduction Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to traditional surgical aortic valve replacement (SAVR) that has been increasingly utilized in the management of aortic stenosis. Several studies have compared the outcomes of TAVR to SAVR, and studies have also compared the clinical outcomes in the elderly population. However, the comparison in outcomes of TAVR between patients more than 80 years and less than 80 years old has not been well characterized. Therefore, in this study, we sought to assess the hospital outcomes and major adverse events of TAVR in patients ≥80 years old compared to those <80 years. Methods We performed a retrospective observational study using the National Inpatient Sample for the year 2018. Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) procedure codes we identified patients who underwent TAVR. We further divided these patients into two cohorts based on age being ≥80 years and <80 years old. The primary outcomes were the comparison of in-hospital mortality and major adverse events (MAE) in patients with TAVR procedure stratified based on age. Secondary analysis included sub-groups analysis of both the cohorts and comparing those with and without MAE as well as comparison of those with MAE only in both cohorts. Results We identified 63,630 patients who underwent TAVR procedures from January 1 to December 31, 2018. Among them, 35, 115(55%) were ≥80 years and 28,515(45%) were <80 years of age. There was no difference in the in-hospital mortality rate (1.6% vs. 1.1%, p=0.89) and rates of MAE (23.8 vs 23.4, p=0.49) between ≥80 and <80year patients. Anemia (aOR-2.12 vs. aOR-1.93), Liver disease (aOR-1.57 vs aOR-1.48), CKD (aOR-1.34 vs. aOR-1.68), history of stroke (aOR-1.54 vs. aOR-1.46), and a higher number of comorbidities were independently associated with higher odds of MAE in both groups. Among patients ≥80, increasing age was also associated with higher MAE (aOR-1.03). In patients who had MAE, those < 80 years had higher comorbidities compared to those ≥80 years (Charlson category ≥3 - 74.5 vs 67%, p<0.001). More patients of age ≥80 years old also belonged to zip-codes with higher median income (p<0.001). On multivariate analysis of patients with MAE on both cohorts, there was no significant difference in in-hospital mortality rate (p=0.65) and length of stay (p=0.12) but total hospital charges were higher for patients less than 80 years of age (283,618 vs 300,624$, p=0.04). However, patients ≥80 years had a higher rate of pacemaker insertion compared to those < 80 years (25.1 vs 24.4%, p=0.008). Conclusion This study shows that in patients undergoing TAVR, the in-hospital mortality and MAE were not statistically significant between those aged ≥80 years and < 80 years. However, among subjects who experienced MAE, those < 80 years had a higher proportion of comorbidities than those ≥80 years of age. Our study also shows that for those above 80 years of age undergoing TAVR, the odds of MAE increases by 3% for each year on increasing age.

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“…[24][25][26] Improved pre-procedural planning, device innovations, operator experience, and evolution of implantation technique have reduced the incidence of serious peri-procedural complications including death, bleeding, and paravalvular leak following TAVR. [27][28][29][30][31] Unfortunately, the occurrence of new onset conduction disturbances including high-grade AVB requiring PPM implantation and new-onset LBBB remain the most common significant complications following TAVR. 32,33 A expert panel statement and meta-analysis have recently summarized the available data on the management, incidence, and prognosis of new onset conduction disturbances following TAVR which provides an excellent overview of the available data and current consensus.…”

Section: Incidence Impact and Mechanism Of New Onset Conduction Disturbances Aortic Stenosismentioning

confidence: 99%

Anatomical Considerations and Emerging Strategies for Reducing New Onset Conduction Disturbances in Percutaneous Structural Heart Disease Interventions

et al. 2021

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Temporal Trends and Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians

Cited by 19 publications

References 28 publications

Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

Comparison of in-hospital mortality and clinical outcomes among patients greater than and less than 80 years undergoing TAVR

Anatomical Considerations and Emerging Strategies for Reducing New Onset Conduction Disturbances in Percutaneous Structural Heart Disease Interventions

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