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Aging Hearts: Transcatheter aortic valve replacement assessment in the nonagenarian population - a single center experience
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 19 - DOENÇA VALVULAR
Speaker:
Tatiana Pereira Dos Santos
Congress:
CPC 2025
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.5 Cardiovascular Disease in the Elderly
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Tatiana Pereira Dos Santos; Ana L. Silva; Mariana Rodrigues Simões; Gonçalo Terleira Batista; Rafaela Fernandes; Tomás M. Carlos; Bernardo Lisboa Resende; Luísa Gomes Rocha; Mafalda Griné; Elisabete Jorge; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif"><span style="color:black">Introduction: Nonagenarians pose a significant challenge for cardiology interventions due to their clinical frailty and comorbidities. Transcatheter aortic valve replacement (TAVR) has demonstrated safety in high surgical risk patients, with more evidence concerning low to intermediate risk patients. The aging population, coupled with a high prevalence of severe aortic stenosis, underscores the need for deeper insights. However, studies and randomized control trials frequently suffer from insufficient representation of this age cohort, hampering our ability to definitively assess the efficacy and safety of interventions in nonagenarians.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif"><span style="color:black">Methods: Retrospective analysis of TAVR patients aged ≥ 90 years at a tertiary hospital (March 2020-June 2024). The purpose was to evaluate the characteristics, outcomes, and safety of patients ≥ 90 years who underwent TAVR for severe aortic stenosis and compare their mortality with younger patients. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif"><span style="color:black">Results: Among 903 patients, 50 were nonagenarians, median age of 91 (IQR 5), and 50% were male. Median follow-up was 506 (IQR 609) days. Cardiovascular (CV) risk factors included: 20% diabetes, 86% hypertension, and 60% dyslipidemia. The majority were in NYHA class II (58%) and III (32%). The mean EuroScore II was 3.16%±2.26%, with a mean LVEF of 55.7%±11.9%, and a mean transaortic gradient of 48.8±13.5 mmHg. Procedurally was used transfemoral access, with 82% self-expandable valves. There were 2 immediate access complications, a hematoma at the primary access site and a vessel rupture, promptly resolved. There was also 1 case of retroperitoneal hematoma. Pacemaker implantation was required in 20%. TAVR patients had an all-cause mortality of 11.1%. For nonagenarians, there were 8 deaths (16%), one due to CV causes (stroke), with the others having unknown causes. Kaplan-Meyer survival analysis showed that the survival rates for nonagenarians versus patients < 90 years of age were 94.0% versus 93.2% at 12 months and 79.1% versus 84.8% at 36 months, with no statistically significant difference (p=0.226). No difference in mortality between sexes (p=0.702). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif"><span style="color:black">Conclusion: This study demonstrates that TAVR appears to be a safe procedure in fit patients aged ≥ 90 years, with a low complications rates and overall mortality comparable to younger patients. A better representation of this subgroup is needed in studies concerning the high prevalence of this disease and high mortality without interventional treatment.</span></span></span></span></span></p>
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