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Updated: Oct 26, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world
Gianluca Pagnoni1,2, Marco Loffi3, Dalia Caleffi4
1Cardiology Unit, Specialistic Medicine Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Background:
The growing number of nonagenarian patients with severe aortic stenosis has increased interest in transcatheter aortic valve implantation (TAVI) in this population. However, data on long-term outcomes remain limited. This study aimed to evaluate long-term survival and procedural outcomes of TAVI in nonagenarians and to explore clinical factors associated with long-term mortality.
Methods:
We conducted an ambispective multicenter observational cohort study including patients aged ≥90 years who underwent TAVI for severe aortic stenosis between 2013 and 2021 at six centers in the Emilia-Romagna region, Italy. Baseline and procedural data were collected retrospectively, while outcome ascertainment combined prospective follow-up contacts with retrospective verification of dates of death or last confirmed vital status. Survival was estimated using the Kaplan-Meier method, and associations with mortality were examined using an exploratory Cox regression analysis.
Results:
A total of 60 nonagenarian patients (mean age 91 ± 1.5 years; 67% female) were included. Procedural success was achieved in 97% of cases. In-hospital mortality was 5%, and 30-day mortality was 8.3%. Over a mean observation period of 5.7 years from TAVI to death or the last confirmed vital-status assessment, the Kaplan-Meier estimated 5-year survival was 35%. In the exploratory multivariable analysis, male sex and chronic obstructive pulmonary disease (COPD) were associated with higher long-term mortality.
Conclusions:
In patients aged ≥90 years selected by the Heart Team for TAVI, the Kaplan-Meier estimated 5-year survival was 35%. The procedure demonstrated a high success rate and an acceptable safety profile. Male sex and COPD showed an exploratory association with worse prognosis. These findings suggest that TAVI may be a feasible option in carefully selected nonagenarians when guided by comprehensive clinical assessment and individualized decision-making.
