transcatheter aortic valve implantation Izo Helber, Leonardo F. - PowerPoint PPT Presentation

Short- and long-term clinical outcomes in nonagenarian patients undergoing transcatheter aortic valve implantation Izo Helber, Leonardo F. Guimarães, Luiz A. Carvalho, Alexandre Abizaid, Rogério Sarmento-Leite, Adriano Dourado, Alexandre Siciliano, Maria Cristina Ferreira, Ênio E. Guerios, Fábio S. Brito Jr., Adriano Caixeta Hospital Israelita Albert Einstein, São Paulo, Brazil; on behalf of Brazilian TAVI Registry

Background • The worldwide population is projected to grow older over the next several decades. • Transcatheter aortic valve implantation (TAVI) has been established as a standart treatment for most patients with aortic stenosis • However, there is a debate about the utility of TAVI in some very high-risk subgroups of patients including nonagenarians

Purpose and key points about methods • We aimed to assess the early and long-term clinical outcomes in nonagenarian patients undergoing TAVI. • January 2008 and February 2015, patients with severe aortic stenosis underwent TAVI and were enrolled in the Brazilian registry. Among a total of 819 patients, 735 were < 90 years and 84 (10.2%) were nonagenarians.

< 90 years Nonagenarians p - value n = 735 n = 84 80.12 ± 7,01 92.45 ± 2,69 Age, years <0.001 Female gender 49.9% 60.7% 0.06 Heart Failure Class III or IV 81.6% 78.6% 0.49 Renal insufficiency 74.7% 96.4% < 0.001 26.49 ± 4.78 24.61 ± 3.87 BMI (Kg/m²) 0.001 9.87 ± 7.71 13.19 ± 8.05 STS score < 0.001 Type of prosthesis 0.65 CoreValve 73.3% 69.0% Sapien XT 23.9% 28.6% 30 DAYS All- cause death 8.4% 15.6 0.03 Stroke 4.0% 2.4% 0.53 Major bleeding 14.5% 15.6 0.73 MACE 12% 19.1% 0.06 1 YEAR All- cause death 21.8% 20.9% 0.81 Stroke 7.4% 5.3% 0.65 MACE 25.8% 27.0% 0.48 Results 2 YEAR All- cause death 30.7% 27.3% 0.95 Stroke 8.5% 5.3% 0.76 MACE 34.4% 33.7% 0.64

Conclusions • In this real world observational study, nonagenarians patients who underwent TAVI had worse short-term outcomes but similar long-term clinical outcomes as compared with patients < 90 years. • The treatment of symptomatic severe aortic stenosis in nonagenarians patients with TAVI deemed to be a non-futility approach.