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Longitudinal Outcomes of Nonagenarians Undergoing Transcatheter Aortic Valve Replacement

July 2, 2021

Transcatheter aortic valve replacement (TAVR) has been established as the preferred alternative to surgical aortic valve replacement in elderly patients. Aortic stenosis is a disease that often effects the elderly population. Without valve replacement, patients may suffer from shortness of breath or chest pain, both of which may lead to recurrent hospitalization. 

The recovery process following open heart surgery involves long recoveries from operation and long hospital stays, making it a less beneficial option for some elderly patients and may leave them hesitant to undergo the procedure. With the advent of TAVR, the recovery time is much shorter, and options for correction have expanded. However, the long-term outcomes of nonagenarians undergoing TAVR are relatively unexplored and unestablished in the literature. As a high-volume TAVR center, UPMC Heart and Vascular Institute interventional cardiologists and cardiac surgeons utilized an institutional patient registry to assess differences in outcomes between more than 800 octogenarian and nonagenarian patients undergoing TAVR.

A recent study published in the May 2021 issue of The Annals of Thoracic Surgery, co-authored by experts from the UPMC Heart and Vascular Institute and the UPMC Center for Heart Valve Disease including senior author Ibrahim Sultan, MD; Catalin Toma, MD; and Dustin Kliner, MD; as well as incoming UPMC Heart and Vascular Institute Advanced Aortic Fellow Valentino Bianco, DO, and University of Pittsburgh School of Medicine MD/PhD student Edgar Aranda-Michel, BS, reviewed an institutional registry of 649 octogenarian and 157 nonagenarian patients undergoing TAVR from 2011 to 2018. Nonagenarians had a lower body mass index, smaller body surface area, and a lower prevalence of chronic obstructive pulmonary disease but a higher Society of Thoracic Surgeons (STS) risk score. Most patients in this study were treated using self-expandable valves via transfemoral access. 

At 30 days, 1 year, and 4 years, there was no difference in survival (95.5%, 80.3%, and 51.2% vs 96.9%, 87.4%, and 57.6%, respectively) and hospital readmissions for cardiac causes between patients in their eighties vs. their nineties. 

“This is a perfect example of thoughtful patient selection by our multidisciplinary heart team,” said Dr. Sultan. “Achieving outstanding outcomes for all our patients is our top priority and the fact that we can safely treat patients well into their nineties with TAVR should be very encouraging and reassuring.”

More importantly, nonagenarians who underwent TAVR at UPMC were also found to have a survival rate comparable to an age-matched and sex-matched U.S. population. Offering the TAVR procedurewith outstanding outcomes is critical for octogenarians and nonagenarians, especially considering 2.5% of Pennsylvania’s population is over the age of 85.   

For more information about UPMC Heart and Vascular Institute or to make a referral, please call UPMC’s 24-hour physician referral service at 1-800-544-2500 or 412-647-7000.