Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature

Fausto Biancari, Paola D'Errigo, Stefano Rosato, Marek Pol, Corrado Tamburino, Marco Ranucci, Fulvia Seccareccia

Research output: Contribution to journalArticle

Abstract

The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 % of patients. Paravalvular regurgitation was observed in 57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access complication 8.8 %, and permanent pacemaker implantation 10.6 %. Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.

Original languageEnglish
Pages (from-to)157-165
Number of pages9
JournalHeart and Vessels
Volume32
Issue number2
DOIs
Publication statusPublished - Feb 2017

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Meta-Analysis
Outcome Assessment (Health Care)
Mortality
Stroke
Heart Valve Diseases
Survival
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis
Blood Vessels
Survival Rate
Morbidity
Safety
Population

Keywords

  • Aged, 80 and over
  • Aortic Valve Stenosis/diagnostic imaging
  • Echocardiography
  • Female
  • Humans
  • Italy
  • Kaplan-Meier Estimate
  • Male
  • Meta-Analysis as Topic
  • Postoperative Complications/epidemiology
  • Prospective Studies
  • Risk Factors
  • Stroke/epidemiology
  • Survival Rate
  • Time Factors
  • Transcatheter Aortic Valve Replacement/adverse effects
  • Treatment Outcome

Cite this

@article{65afbd408b4344ef87bc129f28626ecc,
title = "Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature",
abstract = "The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 {\%}. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 {\%} of patients. Paravalvular regurgitation was observed in 57.5 {\%}. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 {\%}. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 {\%}, stroke 2.8 {\%}, vascular access complication 8.8 {\%}, and permanent pacemaker implantation 10.6 {\%}. Paravalvular regurgitation was observed in 60.1 {\%} of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 {\%}. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.",
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author = "Fausto Biancari and Paola D'Errigo and Stefano Rosato and Marek Pol and Corrado Tamburino and Marco Ranucci and Fulvia Seccareccia",
year = "2017",
month = "2",
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TY - JOUR

T1 - Transcatheter aortic valve replacement in nonagenarians

T2 - early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature

AU - Biancari, Fausto

AU - D'Errigo, Paola

AU - Rosato, Stefano

AU - Pol, Marek

AU - Tamburino, Corrado

AU - Ranucci, Marco

AU - Seccareccia, Fulvia

PY - 2017/2

Y1 - 2017/2

N2 - The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 % of patients. Paravalvular regurgitation was observed in 57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access complication 8.8 %, and permanent pacemaker implantation 10.6 %. Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.

AB - The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 % of patients. Paravalvular regurgitation was observed in 57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access complication 8.8 %, and permanent pacemaker implantation 10.6 %. Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.

KW - Aged, 80 and over

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Echocardiography

KW - Female

KW - Humans

KW - Italy

KW - Kaplan-Meier Estimate

KW - Male

KW - Meta-Analysis as Topic

KW - Postoperative Complications/epidemiology

KW - Prospective Studies

KW - Risk Factors

KW - Stroke/epidemiology

KW - Survival Rate

KW - Time Factors

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

U2 - 10.1007/s00380-016-0857-3

DO - 10.1007/s00380-016-0857-3

M3 - Article

C2 - 27251569

VL - 32

SP - 157

EP - 165

JO - Heart and Vessels

JF - Heart and Vessels

SN - 0910-8327

IS - 2

ER -