Impact of age on long term survival following transcatheter aortic valve implantation

OBJECTIVE: To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population. METHODS: This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis. The study group was divided into two age groups, as those with an age ≥ 80 years (octogenarians, n = 132), and age < 80 (younger patients, n = 142). The two groups were compared in terms of clinical outcomes and survival. In addition, significant predictors of survival were estimated. RESULTS: Non-cardiac mortality (during follow-up) (21.9% vs. 10.5%, P = 0.01) and in-hospital stroke (8.3% vs. 2.8%, P = 0.01) were more common among octogenarians. The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs. 38.2 ± 2.2 months, respectively, P = 0.18). Multivariate analysis identified left ventricular ejection fraction < 35% (OR: 2.17, 95% CI: 1.17–4.03; P = 0.01), preoperative of moderate to severe mitral insufficiency (OR: 1.88, 95% CI: 1.15–3.06; P = 0.01), postoperative major and life-threating bleeding (OR: 2.49, 95% CI: 1.05–5.89; P = 0.03), and in-hospital stroke (OR: 2.29, 95% CI: 1.04–5.04; P = 0.03) as potential predictors of poor survival. CONCLUSIONS: In this study, similarly favorable survival outcomes were achieved in the elderly population as in younger patients, despite the presence of comorbid conditions. A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients, in the absence of co-existent conditions associated with shortened life expectancy.