Is Transcatheter Aortic Valve Implantation Still Effective in Nonagenarians?

Transcatheter aortic valve implantation (TAVI) has become the preferred therapeutic method for elderly patients presenting with severe symptomatic aortic stenosis (AS). Most TAVI procedures are performed in patients between 75-85 years of age. A few publications exist on TAVI in patients over 90 years, yet the outcome and complication rates are inconsistent.

To identify all patients with AS who underwent TAVI between 2019 and 2020, specifically those age > 90 years at the time of the TAVI.

We reviewed the Maccabi Healthcare Services database for all severe/critical AS patients who underwent TAVI between 2019 and 2020, specifically those age > 90 years at the time of TAVI. These patients were compared to all patients aged 80-89 years who underwent TAVI during the same time. Follow-up ended on 31 December 2022. We compared mortality and complications rates in nonagenarians vs. those 80-89 years and evaluated the change in left ventricular ejection fraction before and after the procedure.

We identified 36 nonagenarians who underwent TAVI during the study period, mean age 92.3 years, male:female ratio 15:21. During a mean follow-up period of 3 years, 44% of nonagenarians died, 26% of the control patients died (P < 0.01).

TAVI in nonagenarians is feasible. Total mortality during follow-up was significantly higher in nonagenarians. Overall complication rates were also higher in nonagenarians, mostly due to vascular complications. Left ventricular dysfunction appeared to improve after TAVI, even in nonagenarians.