Mendiz Oscar, Fava Carlos, Cura Fernando, Agatiello Carla, Sztejfman Matias, Damonte Anibal, Londero Hugo, Candiello Alfonsina, Berrocal Daniel
Department of Interventional Cardiology and Cardiovascular Surgery, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.
Department of Interventional Cardiology and Cardiovascular Surgery, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.
Indian Heart J. 2017 Sep-Oct;69(5):597-599. doi: 10.1016/j.ihj.2017.02.017. Epub 2017 Mar 6.
Nonagenarians are mostly denied from different therapeutic strategies due to high preoperative risk. We present the results of nonagenarians with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Our retrospective analysis include baseline and procedural data along with clinical outcome. Clinical follow-up was performed in all patients after TAVR.
Out of 689 patients, 33 nonagenarians with a mean age of 90.9±1.4years suffering from severe AS and elevated comorbidity index (logistic EuroSCORE of 16.3±9.6%, STS score 11.1±9.9%) underwent TAVR between September 2009 and July 2016 using self-expanding prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.64±0.12cm2 with a mean pressure gradient of 56.1±16.1mmHg. Five (16.2%) patients had postprocedural moderate/severe aortic regurgitation. One patient died intraoperally due to ventricular perforation during predilatation, while two patients died within the first 30days, one due to cardiogenic shock and the other due to pneumonia. No patient experienced a myocardial infarction or a stroke, while ten (30.3%) required permanent pacemaker placement. At follow-up (mean 20.3 months, range 1-78 months), all cause and cardiovascular mortality was 24.2% and 15.1%, respectively. Two patients presented heart failure and 12 (40%) had exertional dyspnea. By echo, mean valve area was 1.72±0.12cm2 and mean gradient 11.2±1.4mmHg. Two patients (16.7%) presented moderate aortic regurgitation.
Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with TAVR.
由于术前风险高，大多数九旬老人被排除在不同的治疗策略之外。我们展示了患有严重主动脉瓣狭窄（AS）的九旬老人接受经导管主动脉瓣置换术（TAVR）的结果。
我们的回顾性分析包括基线和手术数据以及临床结果。所有患者在TAVR术后均进行了临床随访。
在689例患者中，33例九旬老人，平均年龄90.9±1.4岁，患有严重AS且合并症指数升高（逻辑欧洲心脏手术风险评估系统评分为16.3±9.6%，胸外科医师协会评分11.1±9.9%），在2009年9月至2016年7月期间使用自膨胀式假体进行了TAVR。基线经胸超声心动图报告平均主动脉瓣面积（AVA）为0.64±0.12cm²，平均压力阶差为56.1±16.1mmHg。5例（16.2%）患者术后出现中度/重度主动脉瓣反流。1例患者在预扩张期间因心室穿孔死于术中，2例患者在术后30天内死亡，1例死于心源性休克，另1例死于肺炎。无患者发生心肌梗死或中风，10例（30.3%）患者需要植入永久性起搏器。在随访（平均20.3个月，范围1 - 78个月）时，全因死亡率和心血管死亡率分别为24.2%和15.1%。2例患者出现心力衰竭，12例（40%）患者有劳力性呼吸困难。经超声心动图检查，平均瓣膜面积为1.72±0.12cm²，平均压力阶差为11.2±1.4mmHg。2例（16.7%）患者出现中度主动脉瓣反流。
我们的病例系列表明，即使合并症指数升高，TAVR治疗的九旬老人的临床终点和瓣膜相关结果相对良好。
