The Society if Thoracic Surgeons (STS) has published a study which opens the door for Transcatheter aortic valve implantation (TAVI) to potentially be used in very elderly patients as an alternative to conventional surgical valve replacement.
According to the STS piece, an aging population means the number of patients who require cardiac surgery has increased among both octogenarians (age 80-89 years) and nonagenarians (age ≥90 years). The problem remains that nearly a third of patients with severe symptomatic valve disease suffer multiple comorbidities or advanced age and are therefore not recommended for surgery.
The new study appears in the January 2014 issue of The Annals of Thoracic Surgery and it claims that TAVI appears to be 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.
Mansanori Yamamoto, MD, and Emmanuel Teiger, MD, both from the Centre Hospitalier Universitaire (CHU)-Henri Mondor in Creteil, France, led a group of researchers examining TAVI results in very elderly patients.
Researchers collected data from 2,254 patients age 80 years and older who underwent 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 three categories based on age: 80-84 years (867 patients), 85-89 years (1,064 patients), and ≥90 years (349 patients).
High procedural success was achieved in every patient age group (97.8%, 96.3%, and 97.1%, respectively), 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).
“Our study found TAVI to provide acceptable clinical results in very elderly populations,” said Dr. Yamamoto. “Elderly patients generally require more time to recover after invasive treatments, such as AVR, so TAVI may have advantages because earlier mobility plays a significant role in maintaining neuromuscular strength and physical function in elderly patients. Smaller incisions allow faster resumption of physical activity and therefore full recovery.”
Source: Society of Thoracic Surgeons