TY - JOUR
T1 - Temporal Trends and Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians
AU - Mentias, Amgad
AU - Saad, Marwan
AU - Desai, Milind Y.
AU - Horwitz, Phillip A.
AU - Rossen, James D.
AU - Panaich, Sidakpal
AU - Elbadawi, Ayman
AU - Qazi, Abdul
AU - Sorajja, Paul
AU - Jneid, Hani
AU - Kapadia, Samir
AU - London, Barry
AU - Vaughan Sarrazin, Mary S.
N1 - Funding Information:
Mentias received support from a National Institutes of Health National Research Service Award institutional grant (T32 HL007121) at the Abboud Cardiovascular Research Center. Vaughan Sarrazin receives support from the National Institute on Aging (R01 AG055663) and the Health Services Research and Development Service of the US Department of Veterans Affairs.
Funding Information:
Mentias received support from a National Institutes of Health National Research Service Award institutional grant (T32 HL007121) at the Abboud Cardiovascular Research Center. Vaughan Sarrazin receives support from the National Institute on Aging (R01 AG055663) and the Health Services Research and Development Service of the US Department of Veterans Affairs.
Funding Information:
Horwitz receives grant support from Edwards Lifesciences and Boston Scientific. Sorajja receives grant support from Edwards Lifesciences, Boston Scientific, Medtronic, Abbott Structural; consulting fees from Edwards Lifesciences, Boston Scientific, Medtronic, Abbott Structural, WL Gore, Admedus, and Cardionomics. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/11/5
Y1 - 2019/11/5
N2 - Background: Contemporary outcomes of transcatheter aortic valve replacement (TAVR) in nonagenarians are unknown. Methods and Results: We identified 13 544 nonagenarians (aged 90–100 years) who underwent TAVR between 2012 and 2016 using Medicare claims. Generalized estimating equations were used to study the change in short-term outcomes among nonagenarians over time. We compared outcomes between nonagenarians and non-nonagenarians undergoing TAVR in 2016. A mixed-effect multivariable logistic regression was performed to determine predictors of 30-day mortality in nonagenarians in 2016. A center was defined as a high-volume center if it performed ≥100 TAVR procedures per year. After adjusting for changes in patients’ characteristics, risk-adjusted 30-day mortality declined in nonagenarians from 9.8% in 2012 to 4.4% in 2016 (P<0.001), whereas mortality for patients <90 years decreased from 6.4% to 3.5%. In 2016, 35 712 TAVR procedures were performed, of which 12.7% were in nonagenarians. Overall, in-hospital mortality in 2016 was higher in nonagenarians compared with younger patients (2.4% versus 1.7%, P<0.05) but did not differ in analysis limited to high-volume centers (2.2% versus 1.7%; odds ratio: 1.33; 95% CI, 0.97–1.81; P=0.07). Important predictors of 30-day mortality in nonagenarians included in-hospital stroke (adjusted odds ratio [aOR]: 8.67; 95% CI, 5.03–15.00), acute kidney injury (aOR: 4.11; 95% CI, 2.90–5.83), blood transfusion (aOR: 2.66; 95% CI, 1.81–3.90), respiratory complications (aOR: 2.96; 95% CI, 1.52–5.76), heart failure (aOR: 1.86; 95% CI, 1.04–3.34), coagulopathy (aOR: 1.59; 95% CI, 1.12–2.26; P<0.05 for all). Conclusions: Short-term outcomes after TAVR have improved in nonagenarians. Several procedural complications were associated with increased 30-day mortality among nonagenarians.
AB - Background: Contemporary outcomes of transcatheter aortic valve replacement (TAVR) in nonagenarians are unknown. Methods and Results: We identified 13 544 nonagenarians (aged 90–100 years) who underwent TAVR between 2012 and 2016 using Medicare claims. Generalized estimating equations were used to study the change in short-term outcomes among nonagenarians over time. We compared outcomes between nonagenarians and non-nonagenarians undergoing TAVR in 2016. A mixed-effect multivariable logistic regression was performed to determine predictors of 30-day mortality in nonagenarians in 2016. A center was defined as a high-volume center if it performed ≥100 TAVR procedures per year. After adjusting for changes in patients’ characteristics, risk-adjusted 30-day mortality declined in nonagenarians from 9.8% in 2012 to 4.4% in 2016 (P<0.001), whereas mortality for patients <90 years decreased from 6.4% to 3.5%. In 2016, 35 712 TAVR procedures were performed, of which 12.7% were in nonagenarians. Overall, in-hospital mortality in 2016 was higher in nonagenarians compared with younger patients (2.4% versus 1.7%, P<0.05) but did not differ in analysis limited to high-volume centers (2.2% versus 1.7%; odds ratio: 1.33; 95% CI, 0.97–1.81; P=0.07). Important predictors of 30-day mortality in nonagenarians included in-hospital stroke (adjusted odds ratio [aOR]: 8.67; 95% CI, 5.03–15.00), acute kidney injury (aOR: 4.11; 95% CI, 2.90–5.83), blood transfusion (aOR: 2.66; 95% CI, 1.81–3.90), respiratory complications (aOR: 2.96; 95% CI, 1.52–5.76), heart failure (aOR: 1.86; 95% CI, 1.04–3.34), coagulopathy (aOR: 1.59; 95% CI, 1.12–2.26; P<0.05 for all). Conclusions: Short-term outcomes after TAVR have improved in nonagenarians. Several procedural complications were associated with increased 30-day mortality among nonagenarians.
KW - elderly
KW - nonagenarians
KW - outcome
KW - transcatheter aortic valve implantation
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U2 - 10.1161/JAHA.119.013685
DO - 10.1161/JAHA.119.013685
M3 - Article
C2 - 31668118
AN - SCOPUS:85074364067
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 21
M1 - e013685
ER -