According to a study published in the January 2014 issue of The Annals of Thoracic Surgery, transcatheter aortic valve implantation (TAVI) is emerging as an effective alternative to surgical aortic valve replacement (AVR) for the treatment of aortic stenosis in very elderly patients, including those age 85 years and older.
As the global population is aging, the number of patients who require cardiac surgery has increased among the very elderly, aged 80 and up and over 90 years of age. Almost one third of patients with severe symptomatic valve disease however, are not recommended for surgery due to multiple comorbidities or their advanced age.
A group of researchers led by Mansanori Yamamoto, MD, and Emmanuel Teiger, MD, both from France’s Centre Hospitalier Universitaire (CHU)-Henri Mondor in Creteil, has conducted a study examining TAVI results in very elderly patients.
The study found TAVI to provide acceptable clinical results in very elderly populations. Dr. Yamamoto explained that these patients generally require longer recovery time after invasive treatments such as AVR, so TAVI may provide advantages due to earlier mobility playing a significant role in maintaining neuromuscular strength and physical function in elderly patients. In conclusion, Dr Yamamoto said that smaller incisions allowed for faster resumption of physical activity and therefore full recovery.
The study included data from over 2000 patients aged 80 years and over, who had undergone TAVI between January 2010 and October 2011 at any of the 34 hospitals participating in the French national TAVI registry (FRANCE-2 Registry).
For the analysis, patients were divided into categories based on their age groups: 80-84 years, consisting of 867 patients, 85-89 years (1,064 patients), and over 90 years (349 patients).
High procedural success of over 95% was achieved in every patient age group and both length of hospital stay and time in the intensive care unit were similar in all groups.
Cumulative mortality rates for the entire patient population were 9.9% at 30-days and 23.8% at 1-year post-surgery. Mortality rates at 1-year were higher among patients in the 85-89 and ≥90 year age groups, compared with the mortality rate in patients in the 80-84 year age group (26.1%, 27.7%, and 19.8%, respectively).
5 January 2014