Higuchi Ryosuke, Kumamaru Hiraku, Kohsaka Shun, Saji Mike, Takamisawa Itaru, Nanasato Mamoru, Shimokawa Tomoki, Shimizu Hideyuki, Takayama Morimasa
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
JACC Asia. 2022 Nov 29;2(7):856-864. doi: 10.1016/j.jacasi.2022.08.007. eCollection 2022 Dec.
Nonagenarians are a growing age group in patients undergoing transcatheter aortic valve replacement (TAVR); however, the appropriate use of TAVR in this population remains discussed because of their limited life expectancy and worse outcome reported.
The authors aimed to evaluate clinical characteristics and the prognostic impact of nonagenarians.
We analyzed consecutive patients undergoing transfemoral TAVR and were registered in the nationwide registry for TAVR in Japan (Japanese Transcatheter Valvular Therapies registry) between 2013 and 2018. The rate of 30-day and 1-year mortality and composite adverse event, comprising all-cause death, all stroke, and life-threatening/major bleeding, were assessed.
Of the 15,028 registered patients during the study period, 2,215 (14.7%) were nonagenarians. Although the nonagenarians were less likely to have comorbid conditions (eg, diabetes mellitus and malignancy) than patients aged <90 y, they had a higher Society of Thoracic Surgeons risk score (8.8% vs 5.6%), mainly owing to their advanced age. The procedural characteristics were identical between 2 groups. The rate of 30-day mortality and composite endpoint was similar, whereas 1-year mortality and composite adverse events were increased among nonagenarians (10.3% vs 6.8% and 13.5% vs 9.2%, respectively), and nonagenarians were independently associated with these endpoints (HR: 1.21; 95% CI: 1.03-1.42; = 0.023; HR: 1.24; 95% CI: 1.07-1.42; = 0.004).
Of the 15,028 TAVR procedures performed in Japan between 2013 and 2018, 14.7% were performed in nonagenarians. These patients were carefully selected by a multidisciplinary heart team and showed 21% and 24% increase of 1-year mortality and composite adverse outcome.
在接受经导管主动脉瓣置换术（TAVR）的患者中，九旬老人是一个不断增长的年龄组；然而，由于其预期寿命有限且报道的预后较差，TAVR在该人群中的合理应用仍存在争议。
作者旨在评估九旬老人的临床特征及其对预后的影响。
我们分析了2013年至2018年间在日本全国TAVR注册登记处（日本经导管瓣膜治疗注册登记处）登记的连续接受经股动脉TAVR的患者。评估了30天和1年死亡率以及包括全因死亡、所有卒中以及危及生命/大出血在内的复合不良事件发生率。
在研究期间登记的15028例患者中，2215例（14.7%）为九旬老人。尽管九旬老人比年龄小于90岁的患者合并症（如糖尿病和恶性肿瘤）较少，但他们的胸外科医师协会风险评分较高（8.8%对5.6%），主要是由于其年龄较大。两组的手术特征相同。30天死亡率和复合终点发生率相似，而九旬老人的1年死亡率和复合不良事件有所增加（分别为10.3%对6.8%和13.5%对9.2%），并且九旬老人与这些终点独立相关（HR：1.21；95%CI：1.03 - 1.42；P = 0.023；HR：1.24；95%CI：1.07 - 1.42；P = 0.004）。
在2013年至2018年期间于日本进行的15028例TAVR手术中，14.7%是针对九旬老人进行的。这些患者由多学科心脏团队精心挑选，显示1年死亡率和复合不良结局分别增加了21%和24%。
