Risk stratification for nonagenarians undergoing transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Geriatric Medicine
• Surgical Outcomes

Background:

• Outcomes for nonagenarians undergoing transcatheter aortic valve replacement (TAVR) are not well-defined compared to younger patients.
• The Society of Thoracic Surgeons (STS) score's utility in identifying high-risk nonagenarians for TAVR requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of the STS score in identifying nonagenarians at higher risk for adverse postoperative outcomes after TAVR.
• To compare TAVR outcomes between intermediate-risk and high-risk nonagenarians and octogenarians.

Main Methods:

• Retrospective analysis of 425 patients (≥80 years) undergoing elective TAVR from 12/2013 to 2/2018.
• Patients stratified into intermediate (STS score 3-8%) and high-risk (>8%) groups.
• Comparison of composite outcomes and 6-month mortality between nonagenarian and octogenarian subgroups.

Main Results:

• 112 nonagenarians (26.4%) and 313 octogenarians (73.6%) were included.
• High-risk nonagenarians (48.2%) had significantly more major perioperative complications and/or 6-month mortality than high-risk octogenarians (24.9%).
• No significant difference in outcomes between intermediate-risk nonagenarians and octogenarians.

Conclusions:

• Intermediate-risk nonagenarians have comparable TAVR outcomes to intermediate-risk octogenarians.
• High-risk nonagenarians experience significantly worse outcomes post-TAVR compared to high-risk octogenarians.
• Judicious patient selection is crucial for high-risk nonagenarians undergoing TAVR.