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Transcatheter aortic valve replacement over age 90: Risks vs benefits
Christos Galatas1, Jonathan Afilalo1
1Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Clinical Cardiology
|December 17, 2019
Summary
Transcatheter aortic valve replacement (TAVR) is a viable option for nonagenarians with severe aortic stenosis, showing good procedural tolerance and survival rates. Patient selection and shared decision-making are crucial for optimizing outcomes in this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Aging populations are increasing the number of nonagenarians with severe aortic stenosis.
- Transcatheter aortic valve replacement (TAVR) is a potential treatment option for this demographic.
- Nonagenarians may exhibit surprising resilience and fewer comorbidities than expected.
Purpose of the Study:
- To evaluate the safety and efficacy of TAVR in nonagenarian patients.
- To determine appropriate patient selection criteria for TAVR in this age group.
- To highlight the importance of frailty assessment and shared decision-making.
Main Methods:
- Review of nonagenarian patients undergoing TAVR.
- Analysis of in-hospital and 1-year mortality rates.
- Assessment of frailty using tools like the Essential Frailty Toolset.
Main Results:
- Nonagenarians tolerated TAVR well, with low in-hospital (5.5%) and 1-year (23%) mortality.
- Frailty assessment is a better predictor of outcomes than chronological age.
- Individualized risk-benefit analysis is key.
Conclusions:
- TAVR is a safe and effective procedure for carefully selected nonagenarians.
- Frailty assessment and shared decision-making are essential for successful TAVR outcomes.
- TAVR can improve quantity and quality of life for nonagenarian patients with severe aortic stenosis.
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