Advanced age and the clinical outcomes of transcatheter aortic valve implantation

Abstract

Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the effect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular injures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.

Keywords: Aortic stenosis; Geriatric; Surgical aortic valve replacement; Transcatheter aortic valve implantation.

Figure 1.. The rates of post TAVI complications depending on patients' age.–

Y axis represents the percentage of post TAVI complications. X axis includes age groups of TAVI patients as presented in Buellesfeld, et al., Havakuk, et al., and Yamamoto, et al., trials. Asterisk represents any statistically significant difference. a: represents the youngest group of TAVI patients with mean age of 73.4 ± 4.5 years; b: represents the second group of TAVI patients with mean age of 80.6 ± 1.1 years; c: represents the third group of TAVI patients with mean age 84.5 ± 1.1 years; d: represents the second group of TAVI patients with mean age 88.9 ± 2.2 years; e: represents patients who are ≤ 85 years old; f: represents patients who are ≥ 85 years old; g: represents patients who are ≤ 90 years old; h: represent patients who are ≥ 90 years old. TAVI: transcatheter aortic valve implantation.