Impact of age on long term survival following transcatheter aortic valve implantation

Abstract

Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population. Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis. The study group was divided into two age groups, as those with an age >= 80 years (octogenarians, n = 132), and age < 80 (younger patients, n = 142). The two groups were compared in terms of clinical outcomes and survival. In addition, significant predictors of survival were estimated. Results Non-cardiac mortality (during follow-up) (21.9% vs. 10.5%, P = 0.01) and in-hospital stroke (8.3% vs. 2.8%, P = 0.01) were more common among octogenarians. The two groups did not differ in terms of mean survival (41.0 +/- 2.1 vs. 38.2 +/- 2.2 months, respectively, P = 0.18). Multivariate analysis identified left ventricular ejection fraction < 35% (OR: 2.17, 95% CI: 1.17-4.03; P = 0.01), preoperative of moderate to severe mitral insufficiency (OR: 1.88, 95% CI: 1.15-3.06; P = 0.01), postoperative major and life-threating bleeding (OR: 2.49, 95% CI: 1.05-5.89; P = 0.03), and in-hospital stroke (OR: 2.29, 95% CI: 1.04-5.04; P = 0.03) as potential predictors of poor survival. Conclusions In this study, similarly favorable survival outcomes were achieved in the elderly population as in younger patients, despite the presence of comorbid conditions. A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients, in the absence of co-existent conditions associated with shortened life expectancy.