Bernard Jérémy, St-Louis Roxanne, Robichaud Mathieu, Kalavrouziotis Dimitri, Dumont Éric, Paradis Jean-Michel, Babaki Shervin, Rodés-Cabau Josep, Mohammadi Siamak
Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada.
Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada.
CJC Open. 2023 Aug 9;5(10):784-791. doi: 10.1016/j.cjco.2023.08.001. eCollection 2023 Oct.
Clinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years.
We conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires.
During the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%.
Nonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.
≥90岁患者经导管主动脉瓣置换术（TAVR）后的临床结局和生活质量（QoL）指标尚未得到充分描述。
我们对2008年至2020年间非agenarian患者的TAVR进行了一项回顾性队列研究。将非agenarian患者中TAVR患者的生存率与省级年龄和性别匹配的普通人群的估计生存率进行比较。使用标准化问卷在干预后长达1年的时间内评估QoL。
在研究期间，对n = 268名≥90岁的严重主动脉瓣狭窄患者进行了评估。171名患者接受了TAVR（48%为女性；中位[IQR]Rockwood临床衰弱量表评分：4[3 - 4]）；84名患者接受了药物治疗；13名患者接受了外科主动脉瓣置换术。与药物治疗后相比，TAVR后的生存率显著更高（调整后的风险比[95%CI]：1.99[1.37 - 2.88]，<0.001）。与普通人群相比，TAVR患者显示出生存优势，估计相对死亡率为0.86（0.75 - 0.87）。与基线相比，TAVR患者在长达1年的时间内功能状态和QoL持续改善（均<0.05）：6分钟步行试验结果从192米提高到252米；堪萨斯城心肌病问卷评分从64提高到81；杜克活动状态指数评分从13提高到16；欧洲生活质量-5维度的健康状态量表结果从63%提高到74%。
与年龄和性别匹配的普通人群相比，接受TAVR的非agenarian患者的生存率略高，并且术后功能状态和多个QoL指标有显著改善。
