Isolated Aortic Valve Replacement in Octogenarians Before and After the Introduction of Trans-catheter Aortic Valve Implantation

Background Trans-catheter aortic valve implantation (TAVI) became available at Auckland City Hospital in 2011 for patients with severe aortic stenosis in whom surgical aortic valve replacement (AVR) was deemed at high risk. We assessed whether introduction of TAVI affected the characteristics and ou...

Full description

Saved in:
Bibliographic Details
Published in:Heart, lung & circulation lung & circulation, 2014-03, Vol.23 (3), p.249-255
Main Authors: Wang, Tom Kai Ming, MBChB, Sathananthan, Janarthanan, MBChB, Ramanathan, Tharumenthiran, PhD, FRACS, Webster, Mark, FRACP, Ruygrok, Peter, MD, FRACP
Format: Article
Language:English
Subjects:
Age
Aged, 80 and over
Aortic stenosis
Aortic valve replacement
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - physiopathology
Aortic Valve Stenosis - surgery
Cardiac Catheterization
Cardiovascular
Disease-Free Survival
Female
Follow-Up Studies
Geriatric
Health Services for the Aged
Heart Valve Prosthesis Implantation
Humans
Male
Retrospective Studies
Survival Rate
Transcatheter aortic valve implantation
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Trans-catheter aortic valve implantation (TAVI) became available at Auckland City Hospital in 2011 for patients with severe aortic stenosis in whom surgical aortic valve replacement (AVR) was deemed at high risk. We assessed whether introduction of TAVI affected the characteristics and outcomes of octogenarians undergoing AVR. Methods Isolated AVR performed in patients ≥80 years of age during 2008–2012 were divided into two groups, pre- and post-TAVI introduction, for analyses. Results Isolated AVR was undertaken in 35 and 33 octogenarians pre- and post-TAVI introduction. The post-TAVI group were older (84.2 vs 82.3 years, P = 0.003), had lower ejection fraction ( P = 0.026), more had inpatient surgery (76% vs 29%, P < 0.001), with higher EuroSCORE II (5.4 vs 3.9%, P = 0.033). Operative mortality was 0.0% in both groups. One-year survival was similar (97.6% vs 94.3%, P = 0.613), but composite morbidity was lower in the post-TAVI group (9.1% vs 31.4%, P = 0.035). Chronic respiratory disease ( P = 0.043) independently predicted mortality during follow-up, while number of coronary vessel > 50% stenosis ( P = 0.050), creatinine clearance ( P = 0.016) and being in the pre-TAVI era group ( P = 0.022) predicted composite morbidity. Conclusions Since TAVI was introduced, mean age and risk scores significantly increased in octogenarians undergoing AVR, while mortality rates remained similar and composite morbidity decreased.
ISSN:1443-9506
1444-2892
DOI:10.1016/j.hlc.2013.10.083