Cardiology Division, Interventional Cardiology Unit, University Hospital of Geneva, Switzerland.
Eur J Intern Med. 2013 Dec;24(8):750-5. doi: 10.1016/j.ejim.2013.07.007. Epub 2013 Aug 7.
The number of nonagenarians is rising dramatically. These patients often develop severe aortic stenosis for which transcatheter aortic valve implantation (TAVI) is an attractive option. The aim of this study was to analyze the outcome of TAVI performed in a cohort of nonagenarian patients.
Between August 2008 and November 2012, 23 consecutive patients in their 90th year of age or older underwent TAVI in our institution after having been assessed by the local heart team. Data concerning baseline characteristics, procedural details and outcome were prospectively entered into a dedicated database. Transthoracic echocardiography and clinical follow-up were performed pre-procedure, at discharge, at 6 and 12 months and then annually post TAVI.
Patients were male in 52% with a mean age of 90.3 ± 2.3 years. Mean logistic EuroSCORE and STS score were 26.6 ± 14.5% and 8.7 ± 2.9%, respectively. Transcatheter heart valve (THV) could be implanted in all but one patient. Mortality at 30 days was 8.7% overall and 4.8% for transfemoral approach. At 30 days the rate of stroke was 4.3%, paravalvular leak grade ≥ 2 was 8.7%, life-threatening bleeding was 13.0% and pacemaker implantation was 13%. Device success was 73.9%. The rate of all-cause mortality increased to 27.3% at one-year follow-up and 42.8% at a median follow-up of 417 days.
TAVI is safe and effective even in a selected population of nonagenarians. Consequently, these patients should not be refused such a procedure based only on their age. Multi-disciplinary assessment is essential in order to properly select candidates.
九十岁以上人口数量显著增加。这些患者通常会发展为严重的主动脉瓣狭窄，经导管主动脉瓣植入术（TAVI）是一种有吸引力的选择。本研究旨在分析我们机构中一组 90 岁以上患者行 TAVI 的结果。
在当地心脏团队评估后，2008 年 8 月至 2012 年 11 月期间，我们机构对 23 例连续 90 岁或以上的患者进行了 TAVI。有关基线特征、手术细节和结果的数据被前瞻性地输入到一个专用数据库中。在术前、出院时、术后 6 个月和 12 个月以及 TAVI 后每年进行经胸超声心动图和临床随访。
患者中男性占 52%，平均年龄为 90.3±2.3 岁。平均逻辑 EuroSCORE 和 STS 评分分别为 26.6±14.5%和 8.7±2.9%。除 1 例患者外，所有患者均能植入经导管心脏瓣膜（THV）。总的 30 天死亡率为 8.7%，经股动脉入路为 4.8%。30 天的卒中发生率为 4.3%，瓣周漏≥2 级为 8.7%，危及生命的出血为 13.0%，需要植入起搏器为 13%。器械成功率为 73.9%。1 年随访时全因死亡率增加至 27.3%，中位随访 417 天时增加至 42.8%。
即使在 90 岁以上患者的选择人群中，TAVI 也是安全有效的。因此，不应仅基于年龄拒绝这些患者接受该手术。多学科评估对于正确选择患者至关重要。
