SPC365

TAVI in Nonagenarians: Distinct Outcomes in Healthy Survivors

Session: Sessão de Posters 45 - Populações especiais, riscos especiais
Speaker: Rita Louro

Congress: CPC 2026
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.5 Cardiovascular Disease in the Elderly
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Rita Louro; Rafael Viana; Marta Figueiredo; Raquel Silva; Rute Vitorino; Rita Rocha; Gustavo Sá Mendes; Diogo Brás; David Neves; Ângela Bento; Renato Fernandes; Lino Patrício

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Background</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Severe aortic stenosis is increasingly encountered in adults aged &ge;90 years, creating uncertainty about intervention in the setting of limited life expectancy and competing mortality risks. Although age is often viewed as a marker of procedural risk, nonagenarians selected for TAVI frequently represent healthy survivors with preserved physiological reserve. Evidence from community centres without surgical backup remains scarce.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">We analysed 463 consecutive TAVI procedures at a single centre without on-site cardiac surgery. Outcomes included peri-procedural complications (periprosthetic leak, high-grade atrioventricular block, vascular and haemorrhagic events, stroke, acute kidney injury and death &le;7 days), 30-day and one-year all-cause mortality, cardiovascular readmission and clinical improvement.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Thirty-nine patients (8.4%) were aged &ge;90 years. Compared with younger patients (&lt;90, n=424), nonagenarians had similar cardiovascular profiles but less coronary artery disease and no previous stroke or CABG, consistent with biological selection. Despite more severe stenosis and higher risk scores, peri-procedural and 30-day outcomes were comparable.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">At one year, all-cause mortality was higher in nonagenarians (34.6% vs 10.0%, p&lt;0.05), while cardiovascular readmissions and symptomatic improvement were similar. No death due to cardiovascular causes was registered. Deaths were often infection or frailty-related, including cases treated as a bridge to major non-cardiac surgery. This pattern suggests long-term outcomes are shaped by age-related competing risks rather than procedural failure, consistent with the healthy survivor framework.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Importantly, in nonagenarians, the clinical value of TAVI lies primarily in improving symptoms and reducing heart-failure burden rather than prolonging survival. For these patients, maintaining functional status, preventing recurrent decompensation, and avoiding hospitalisations are often more meaningful outcomes than incremental gains in life expectancy.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">It is nonetheless crucial to recognise the difference in 1-year mortality, underlining the need to better identify the healthy survivors. Patients with substantial comorbidities are less likely to derive meaningful benefit from the procedure and should be carefully selected.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">In these patients, the benefit of TAVI should be evaluated by its capacity to preserve autonomy and clinical stability, rather than survival alone.</span></span></span></p>