McNeely Christian, Zajarias Alan, Robbs Randall, Markwell Stephen, Vassileva Christina M
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Ann Thorac Surg. 2017 Jun;103(6):1808-1814. doi: 10.1016/j.athoracsur.2017.02.056. Epub 2017 Apr 24.
Survival and other outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) in the Medicare population are unclear.
Patients aged 65 years and older who underwent TAVR from November 2011 through 2013 were considered for inclusion.
The study consisted of 18,283 patients and 19.3% were aged 90 years or older. Compared with patients younger than 90 years, patients 90 years or older were less likely to have a number of comorbidities, including previous myocardial infarction (17.5% versus 21.8%), previous coronary artery bypass grafting (20.0% versus 35.0%), and chronic obstructive pulmonary disease (25.4% versus 39.0%) among others. The 30-day and 1-year mortality rates were 8.4% versus 5.9% (p = 0.0001) and 25.4% versus 21.5% (p = 0.0001) in the older and younger groups, respectively (odds ratio [OR] 1.47, 95% confidence interval [CI]: 1.28 to 1.70, p = 0.0001). Patients 90 years and older were more likely to undergo pacemaker insertion (11.1% versus 8.3%, p = 0.0001). Among nonagenarians, compared with the transapical group, patients undergoing transfemoral TAVR had lower 30-day (7.2% versus 13.6%, p = 0.0001) and 1-year (23.8% versus 31.6%, p = 0.0001) mortality rates, were more likely to be discharged home (54.4% versus 34.1%, p = 0.0001), and had lower 30-day readmission rates (23.8% versus 31.8%, p = 0.0001). After adjustment for patient characteristics, transapical TAVR was an independent predictor of 30-day mortality rate (OR 1.94, 95% CI: 1.48 to 2.56, p = 0.0001) and readmission (OR 1.46, 95% CI: 1.19 to 1.80, p = 0.0003).
In patients undergoing TAVR, although 30-day and 1-year mortality rates were slightly worse for nonagenarians than their younger counterparts, long-term survival was still encouraging, with 75% of nonagenarians living to 1 year. Transapical TAVR was associated with worse outcomes in nonagenarians.
医疗保险人群中接受经导管主动脉瓣置换术（TAVR）的九旬老人的生存情况及其他预后尚不清楚。
纳入2011年11月至2013年期间接受TAVR的65岁及以上患者。
该研究共纳入18283例患者，其中19.3%的患者年龄在90岁及以上。与90岁以下患者相比，90岁及以上患者的多种合并症发生率较低，包括既往心肌梗死（17.5%对21.8%）、既往冠状动脉旁路移植术（20.0%对35.0%）、慢性阻塞性肺疾病（25.4%对39.0%）等。老年组和年轻组的30天死亡率分别为8.4%和5.9%（p = 0.0001），1年死亡率分别为25.4%和21.5%（p = 0.0001）（优势比[OR]1.47，95%置信区间[CI]：1.28至1.70，p = 0.0001）。90岁及以上患者更有可能接受起搏器植入（11.1%对8.3%，p = 0.0001）。在九旬老人中，与经心尖组相比，经股动脉TAVR患者的30天（7.2%对13.6%，p = 0.0001）和1年（23.8%对31.6%，p = 0.0001）死亡率更低，更有可能出院回家（54.4%对34.1%，p = 0.0001），30天再入院率更低（23.8%对31.8%，p = 0.0001）。在对患者特征进行调整后，经心尖TAVR是30天死亡率（OR 1.94，95% CI：1.48至2.56，p = 0.0001）和再入院（OR 1.46，95% CI：1.19至1.80，p = 0.0003）的独立预测因素。
在接受TAVR的患者中，尽管九旬老人的30天和1年死亡率略高于年轻患者，但其长期生存率仍令人鼓舞，75%的九旬老人存活至1年。经心尖TAVR与九旬老人的预后较差相关。
