Author + information
- Michael Catalano,
- Robert Palazzo,
- Bruce Rutkin,
- Hugh Cassiere,
- Gregory Maurer,
- Jacinda Berg,
- Alan Hartman and
- Pey-Jen Yu
Nonagenarians have been shown to have increased but acceptable morbidity and mortality following transcatheter aortic valve replacement (TAVR) as compared to younger cohorts. The purpose of this study is determine if STS score can be used to identify the subset of nonagenarians that have significantly higher risk for poor postoperative outcomes after TAVR.
A total of 425 patients above the age of 80 underwent TAVR from 12/2013 to 2/2018 and were included in this study. Patients were deemed intermediate- and high-risk based on their STS predicted risk of surgical mortality of 3–8% and > 8%, respectively. Differences in postoperative outcomes and 6-month mortality between intermediate- and high-risk octogenarians and nonagenarians were compared.
Of the 425 patients, 112 (26.3%) patients were nonagenarians, and 313 (73.6%) patients were octogenarians. Fifty-four (48.2%) of the nonagenarians were stratified as high-risk while 78 (24.9%) of the octogenarians were stratified as high-risk. There were no statistically significant differences in outcomes between intermediate-risk nonagenarians as compared to intermediate-risk octogenarians. In contrast, high-risk nonagenarians were significantly more likely to experience the composite outcome of major perioperative complications and/or 6-month mortality as compared to high-risk octogenarians (29.63% vs. 15.38%, p = 0.049, Table 1).
Intermediate-risk nonagenarians undergoing TAVR have similar postoperative outcomes as compared to intermediate-risk octogenarians. However, high-risk nonagenarian patients undergoing TAVR experience significantly poorer outcomes compared to their octogenarian counterparts. Judicious patient selection for TAVR in this subgroup of patients is therefore warranted.
|Octogenarians (n=313)||Nonagenarians (n=112)||p-value|
|Intermediate Risk Patients|
|STS score, median (IQR)||4.9 (3.9-6.1)||6.3 (5.6-7.0)||<0.001|
|Total Complications/Death (%)||21 (8.94%)||4 (6.90%)||0.618|
|High Risk Patients|
|STS score, median (IQR)||10.4 (9.2-13.0)||10.8 (9.3-13.9)||0.582|
|Total Complications/Death (%)||12 (15.38%)||16 (29.63%)||0.049|