Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patien...Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis.The study group was divided into two age groups,as those with an age ≥ 80 years (octogenarians,n = 132),and age < 80 (younger patients,n = 142).The two groups were compared in terms of clinical outcomes and survival.In addition,significant predictors of survival were estimated.Results Non-cardiac mortality (during follow-up)(21.9% vs.10.5%,P = 0.01) and in-hospital stroke (8.3% vs.2.8%,P = 0.01) were more common among octogenarians.The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs.38.2 ± 2.2 months,respectively,P =0.18).Multivariate analysis identified left ventricular ejection fraction < 35%(OR: 2.17,95% CI: 1.17–4.03;P = 0.01),preoperative of moderate to severe mitral insufficiency (OR: 1.88,95% CI: 1.15–3.06;P = 0.01),postoperative major and life-threating bleeding (OR: 2.49,95% CI: 1.05–5.89;P =0.03),and in-hospital stroke (OR: 2.29,95% CI: 1.04–5.04;P = 0.03) as potential predictors of poor survival.Conclusions In this study,similarly favorable survival outcomes were achieved in the elderly population as in younger patients,despite the presence of comorbid conditions.A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients,in the absence of co-existent conditions associated with shortened life expectancy.展开更多
Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement (TAVR) when one considers the potential improvement in the q...Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement (TAVR) when one considers the potential improvement in the quality of life (QoL) on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. Methods This prospective cohort study included 136 elderly patients (70 to 89 years of age), who tmderwent Wansfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups: septuagenarians (n = 67) and octogenarians (n = 69). Preoperative and early postoperative clinical parameteT:s were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. Results Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association (NYHA) class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group (P = 0.02, 0.01, 0.03, respectively). ConcLusion Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the QoL and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.展开更多
文摘Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis.The study group was divided into two age groups,as those with an age ≥ 80 years (octogenarians,n = 132),and age < 80 (younger patients,n = 142).The two groups were compared in terms of clinical outcomes and survival.In addition,significant predictors of survival were estimated.Results Non-cardiac mortality (during follow-up)(21.9% vs.10.5%,P = 0.01) and in-hospital stroke (8.3% vs.2.8%,P = 0.01) were more common among octogenarians.The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs.38.2 ± 2.2 months,respectively,P =0.18).Multivariate analysis identified left ventricular ejection fraction < 35%(OR: 2.17,95% CI: 1.17–4.03;P = 0.01),preoperative of moderate to severe mitral insufficiency (OR: 1.88,95% CI: 1.15–3.06;P = 0.01),postoperative major and life-threating bleeding (OR: 2.49,95% CI: 1.05–5.89;P =0.03),and in-hospital stroke (OR: 2.29,95% CI: 1.04–5.04;P = 0.03) as potential predictors of poor survival.Conclusions In this study,similarly favorable survival outcomes were achieved in the elderly population as in younger patients,despite the presence of comorbid conditions.A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients,in the absence of co-existent conditions associated with shortened life expectancy.
文摘Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement (TAVR) when one considers the potential improvement in the quality of life (QoL) on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. Methods This prospective cohort study included 136 elderly patients (70 to 89 years of age), who tmderwent Wansfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups: septuagenarians (n = 67) and octogenarians (n = 69). Preoperative and early postoperative clinical parameteT:s were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. Results Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association (NYHA) class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group (P = 0.02, 0.01, 0.03, respectively). ConcLusion Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the QoL and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.