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Multicenter Study
. 2021 May 10;14(9):952-960.
doi: 10.1016/j.jcin.2021.01.042. Epub 2021 Apr 14.

Age-Related Outcomes After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry

Adrian Attinger-Toller  1 , Enrico Ferrari  2 , David Tueller  3 , Christian Templin  4 , Olivier Muller  5 , Fabian Nietlispach  6 , Stefan Toggweiler  7 , Stéphane Noble  8 , Marco Roffi  8 , Raban Jeger  9 , Christoph Huber  10 , Thierry Carrel  11 , Thomas Pilgrim  12 , Peter Wenaweser  13 , Mario Togni  14 , Stéphane Cook  14 , Dik Heg  15 , Stephan Windecker  12 , Jean-Jacques Goy  14 , Stefan Stortecky  12
Affiliations
Free article
Multicenter Study

Age-Related Outcomes After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry

Adrian Attinger-Toller et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to investigate age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study.

Background: TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups.

Methods: Data from the SwissTAVI Registry were analyzed. Clinical outcomes were compared between patients 70 years of age or younger (n = 324), 70 to 79 years of age (n = 1,913), 80 to 89 years of age (n = 4,353), and older than 90 years of age (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios.

Results: Between February 2011 and June 2018, 7,097 patients (mean age 82.0 ± 6.4 years, 49.6% women) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio [HRadj]: 1.45; 95% confidence interval [CI]: 1.18 to 1.77; 1-year HRadj: 1.12; 95% CI: 1.01 to 1.24), cerebrovascular accidents (30-day HRadj: 1.35; 95% CI: 1.09 to 1.66; 1-year HRadj: 1.21; 95% CI: 1.02 to 1.45), and pacemaker implantation (30-day HRadj: 1.23; 95% CI: 1.12 to 1.34; 1-year HRadj: 1.19; 95% CI: 1.09 to 1.30) was observed with increasing age. Furthermore, standardized mortality ratios were 12.63 (95% CI: 9.06 to 17.58), 4.09 (95% CI: 3.56 to 4.74), 1.63 (95% CI: 1.50 to 1.78), and 0.93 (95% CI: 0.76 to 1.14) for TAVR patients in relation to the Swiss population <70, 70 to 79, 80 to 89 and ≥90 years of age, respectively.

Conclusions: Increasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer-term follow-up after TAVR. Standardized mortality ratios were higher for TAVR patients younger than 90 years of age compared with expected rates of mortality in an age- and sex-matched Swiss population. (SWISS TAVI Registry; NCT01368250).

Keywords: age; aortic stenosis; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures The SwissTAVI Registry is supported by a study grant from the Swiss Heart Foundation and the Swiss Working Group of Interventional Cardiology and Acute Coronary Syndromes and is sponsored by research grants from Medtronic, Edwards Lifesciences, Boston Scientific, and Abbott. The study sponsors had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. Dr. Stortecky has received research grants to the institution from Edwards Lifesciences, Medtronic, Abbott Vascular, and Boston Scientific; serves as consultant for BTG and Teleflex; and has received speaker fees from BTG and Boston Scientific. Dr. Templin has received fees outside the submitted work for serving on advisory boards for AstraZeneca and Amgen; has served as a consultant for Schnell Medical and Shockwave; has received travel support from Abbott Vascular, Biosensors, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received research grant support from Abbott Vascular. Dr. Toggweiler serves as a consultant and proctor for Boston Scientific, Biosensors/New Valve Technology; serves as a proctor for Abbott Vascular; serves as a consultant for Carag; has received speaker honoraria from Medtronic; and is a board member of and holds equity in Hi-D Imaging. Dr. Heg is affiliated with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern is involved in the design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations. In particular, pharmaceutical and medical device companies provide direct funding to some of these studies. For an up-to-date list of CTU Bern’s conflicts of interest, see http://www.ctu.unibe.ch/research/declaration_of_interest/index_eng.html. Dr. Pilgrim has received research grants to the institution from Biotronik and Boston Scientific; has received speaker fees from Boston Scientific and Biotronik; and has received consultancy fees from HighLife SAS. Dr. Muller serves as consultant for Abbott; and has received speaker fees from Edwards Lifesciences. Dr. Ferrari is a proctor and consultant for Edwards Lifesciences. Dr. Huber has served as a proctor for Edwards Lifesciences and Boston Scientific/Symetis. Dr. Jeger has received institutional research grants from B. Braun Melsungen; and has received speaker honoraria from B. Braun Melsungen, Cardionovum, and Nipro. Dr. Roffi has received institutional research grants from Boston Scientific, Biotronik, Terumo, Medtronic, and GE Healthcare. Dr. Tüller has received speaker fees from Edwards Lifesciences and Boston Scientific; and has received reimbursement for travel expenses from Edwards Lifesciences, Boston Scientific, and Medtronic. Dr. Nietlispach has served as a consultant for Abbott, Edwards Lifesciences, and Medtronic. Dr. Wenaweser is a proctor for Edwards Lifesciences and Medtronic; and has served as consultant for Edwards Lifesciences, Medtronic, and Cardinal Health (fellow training). Dr. Windecker has received research and educational grants to the institution from Abbott, Amgen, Bristol Myers Squibb, Bayer, Boston Scientific, Biotronik, Cardinal Health, CardioValve, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Johnson & Johnson, Medtronic, Querbet, Polares, Sanofi, Terumo, and Sinomed; serves as an unpaid member of the steering or executive groups of trials funded by Abbott, Abiomed, Amgen, Bristol Myers Squibb, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Polares, Sinomed, V-Wave, and Xeltis (but has not received personal payments from any pharmaceutical company or device manufacturer); and is a member of the steering or executive committee groups of several investigated-initiated trials that receive funding from industry without impact on his personal remuneration. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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