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Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY)

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Abstract

Objective

The aim of this study was to compare the outcome of nonagenarians (≥ 90 years) with that of younger (< 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice.

Methods

Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients.

Results

Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p < 0.001), frail (38.7% vs. 34.7%, p < 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p < 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p > 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age ≥ 90 years could be identified as an isolated risk factor for mortality.

Conclusion

TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients—most probably due to the intrinsic higher risk profile of the very old patients—the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.

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Funding

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany

    J. Blumenstein & H. Möllmann

  2. Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany

    S. Bleiziffer

  3. Department of Cardiology, Sana-Klinikum, Offenbach, Germany

    T. Bauer

  4. Department of Thoracic and Cardiovascular Surgery, University Hospital, Lübeck, Germany

    S. Ensminger

  5. Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany

    R. Bekeredjian

  6. Department of Thoracic and Cardiovascular Surgery, University Hospital, Frankfurt, Germany

    T. Walther

  7. Department of Cardiology, University Hospital, Heart Center, Cologne, Germany

    C. Frerker

  8. Department of Thoracic and Cardiovascular Surgery, University Hospital, Heart Center, Freiburg, Germany

    F. Beyersdorf

  9. Department of Medical Clinic I, University Hospital, Giessen, Germany

    C. Hamm

  10. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany

    C. Hamm

  11. Deutsche Gesellschaft für Thorax, Herz- Und Gefäßchirurgie, Berlin, Germany

    A. Beckmann

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  1. J. Blumenstein
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  2. H. Möllmann
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  4. T. Bauer
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  7. T. Walther
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  9. F. Beyersdorf
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  10. C. Hamm
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  11. A. Beckmann
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Correspondence to H. Möllmann.

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Blumenstein, J., Möllmann, H., Bleiziffer, S. et al. Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY). Clin Res Cardiol 109, 1099–1106 (2020). https://doi.org/10.1007/s00392-020-01601-4

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  • DOI: https://doi.org/10.1007/s00392-020-01601-4

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