TAVR improves long-term survival in the very old

Nonagenarians with severe aortic stenosis (AS) enjoy long-term survival benefits after transcatheter aortic valve replacement (TAVR), a recent study has found.

Researchers enrolled 1,052 consecutive patients with severe AS scheduled for TAVR, who were divided into three groups according to their age at the time of the procedure: 80–84 years (group 1; n=658), 85–89 years (group 2; n=326) and ≥90 years (group 3; n=68). Patient survival after TAVR were compared among groups and against an age- and sex-matched general-population control.

Patients in group 3 were significantly more likely to develop major access-site complications than their younger comparators (7.6 percent vs 10.1 percent vs 17.6 percent; p=0.016). Nonagenarians also had greater need for blood transfusion (24.1 percent vs 32.5 percent vs 38.2 percent; p=0.003).

The composite endpoint―life-threatening bleeding, stroke, stage 2/3 acute kidney injury, major vascular complications, coronary obstruction requiring intervention, repeat procedures for valve-related dysfunction and all-cause mortality―occurred more frequently in the oldest patient group (13.5 percent vs 17.5 percent vs 27.9 percent; p=0.004).

Compared to a general-population cohort, nonagenarians showed greater 1-year mortality after being treated with TAVR (27.8 percent vs 20.0 percent). Mortality curves converged by year 2 (39.2 percent vs 37.5 percent) and reversed positions after 5 years, such that survival was better in those who received TAVR (mortality rates: 59.2 percent vs 74.2 percent).

This underscores the importance of TAVR and its efficacy for improving survival, even in an elderly population of patients, researchers said.