Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis

Antonio Grimaldi, Filippo Figini, Francesco Maisano, Matteo Montorfano, Alaide Chieffo, Azeem Latib, Federico Pappalardo, Pietro Spagnolo, Micaela Cioni, Anna Chiara Vermi, Santo Ferrarello, Daniela Piraino, Valeria Cammalleri, Enrico Ammirati, Francesco Maria Sacco, Iryna Arendar, Egidio Collu, Giovanni La Canna, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Objective: TAVI is the alternative option in pts with AS deemed ineligible for surgery. Although mortality and morbidity are measures to assess the effectiveness of treatments, quality of life (QOL) should be an additional target. We assessed clinical outcome and QOL in octogenarians following TAVI. Design: All octogenarians with a risk profile considered by the Heart Team to be unacceptable for surgery entered in this registry. QOL was assessed by questionnaires concerning physical and psychic performance. Patients: A hundred forty-five octogenarians (age: 84.7 ± 3.4 years; male: 48.3%) underwent TAVI for AS (97.2%) or isolated AR (2.8%). NYHA class: 2.8 ± 0.6; Logistic EuroScore: 26.1 ± 16.7; STS score: 9.2 ± 7.7.Echocardiographic assessments included AVA (0.77 ± 0.21 cm2), mean/peak gradients (54.5 ± 12.2/88 ± 19.5 mmHg), LVEF (21% = EF ≤ 40%), sPAP (43.1 ± 11.6 mmHg). Interventions: All pts underwent successful TAVI using Edward-SAPIEN valve (71.2%) or Medtronic CoreValve (28.8%). Main outcome measures: Rates of mortality at 30 days, 6 months and 1 year were 2.8%, 11.2% and 17.5%. Results: At 16-month follow up, 85.5% survived showing improved NYHA class (2.8 ± 0.6 vs 1.5 ± 0.7; p <0.001), decreased sPAP (43.1 ± 11.6 mmHg vs 37.1 ± 7.7 mmHg; p <0.001) and increased LVEF in those with EF ≤ 40% (34.9 ± 6% vs 43.5 ± 14.4%; p = 0.006). Concerning QOL, 49% walked unassisted, 79% (39.5% among pts ≥ 85 years) reported self-awareness improvement; QOL was reported as "good" in 58% (31.4% among pts ≥ 85 years), "acceptable according to age" in 34% (16% among pts ≥ 85 years) and "bad" in 8%. Conclusion: TAVI procedures improve clinical outcome and subjective health-related QOL in very elderly patients with symptomatic AS.

Original languageEnglish
Pages (from-to)281-286
Number of pages6
JournalInternational Journal of Cardiology
Volume168
Issue number1
DOIs
Publication statusPublished - Sep 20 2013

Keywords

  • Aortic stenosis
  • Quality of life
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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