Department of Cardiology, Agaplesion General Hospital Hagen, Hagen, Germany.
Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
Herz. 2021 Sep;46(Suppl 2):222-227. doi: 10.1007/s00059-020-04986-0. Epub 2020 Oct 7.
The prevalence of aortic valve stenosis is increasing due to the continuously growing geriatric population. Data on procedural success and mortality of very old patients are sparse, raising the question of when this population may be deemed as "too old even for transcatheter aortic valve replacement (TAVR)." We, therefore, sought to evaluate the influence of age on outcome after TAVR and the impact of direct implantation.
The data of 394 consecutive patients undergoing TF-TAVR were analyzed. Patients were divided into four age groups: ≤75 (group 1, n = 28), 76-80 (group 2, n = 107), 81-85 (group 3, n = 148), and >85 (group 4, n = 111) years. Direct implantation was performed when possible according to current recommendations. Survival was evaluated by Kaplan-Meier analysis.
Mortality at 30 days and 1 year was not significantly different between the four age groups (3.6 vs. 6.7 vs. 5.4 vs. 2.7% and 7.6 vs. 17 vs. 14.5 vs. 13%m respectively, log-rank p = 0.59). Direct implantation without balloon aortic valvuloplasty was more frequently performed on patients aged >85 vs. ≤85 years (33.3 vs. 14.1%, p < 0.001). the incidence of procedural complications frequently associated with advanced age (stroke, vascular complications) was not significantly increased in group 4.
Outcome after TF-TAVR is comparable among different age cohorts, even in very old patients. Direct implantation simplifies the procedure and could therefore play a role in reducing the incidence of peri-interventional complications in patients of advanced age.
由于不断增长的老年人口，主动脉瓣狭窄的患病率正在增加。关于非常高龄患者的手术成功率和死亡率的数据很少，这引发了一个问题，即何时认为该人群“太老，即使进行经导管主动脉瓣置换术（TAVR）也不行”。因此，我们试图评估年龄对 TAVR 后结果的影响，以及直接植入的影响。
分析了 394 例连续接受 TF-TAVR 的患者的数据。患者被分为四个年龄组：≤75 岁（组 1，n=28）、76-80 岁（组 2，n=107）、81-85 岁（组 3，n=148）和>85 岁（组 4，n=111）。根据当前建议，在可能的情况下进行直接植入。通过 Kaplan-Meier 分析评估生存情况。
四个年龄组之间 30 天和 1 年的死亡率无显著差异（分别为 3.6%、6.7%、5.4%和 2.7%和 7.6%、17%、14.5%和 13%，对数秩检验 p=0.59）。与≤85 岁患者相比，>85 岁患者更常进行无球囊主动脉瓣成形术的直接植入（33.3% vs. 14.1%，p<0.001）。与高龄相关的手术并发症（中风、血管并发症）的发生率在第 4 组中没有显著增加。
TF-TAVR 后的结果在不同年龄组之间是可比的，即使是在非常高龄的患者中也是如此。直接植入简化了手术程序，因此可以在降低高龄患者围手术期并发症发生率方面发挥作用。
