Comparative Effectiveness of Transcatheter Aortic Valve Replacement (TAVR) in Nonagenarians Compared with Younger Patients
Abstract
Pasquale Marotta, Samip Vasaiwala, Philip Lacombe, Kelsey Klingel, Scott Buchanan, Marco Diaz and David Butzel
Background: TAVR has garnered worldwide acceptance as a suitable alternative to surgical AVR in many clinical situations, particularly in the elderly. Our goal was to study whether some of the known benefits from TAVR might be superseded by risks in the nonagenarian population [1].
Methods: Using Cox proportional hazards method, we retrospectively analyzed 1246 patients age > 50 years undergoing TAVR at our institution from the STS/ACC TVT database between 2010-2020. Patients age > 90 were compared with younger patients with coprimary endpoints of inpatient mortality and major bleeding requiring transfusion, 1-yr mortality, and 30-day all cause readmission.
Results: Baseline demographic, clinical characteristics, and unadjusted outcomes in primary endpoints are presented in Table 1. Primary endpoints did not differ across the two groups. Inpatient mortality (Odds Ratio 2.23 [0.62, 8.00]; p=0.22), 1-year mortality (HR 1.64 [0.78, 3.44]; p =0.19), and 30-day hospital readmission rates (HR 0.84 [0.39, 1.81]; p=0.66) were similar prior to and after adjustment for baseline differences.
Conclusions: In our study, no differences in hard clinical endpoints were detected between a younger and advanced aged population of patients treated with TAVR. Our study highlights that TAVR can be safely performed in patients of extreme age with clinical outcomes similar to a younger patient population when properly selecting patients for this procedure.