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Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature

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Abstract

The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 % of patients. Paravalvular regurgitation was observed in 57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access complication 8.8 %, and permanent pacemaker implantation 10.6 %. Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.

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Acknowledgements

The OBSERVANT Study was supported by a Grant (Fasc. 1M30) from Italian Ministry of Health and Istituto Superiore di Sanità. The authors thank Gabriella Badoni for her technical support in the organizational phases of the study. Fulvia Seccareccia, Paola D’Errigo, Stefano Rosato, Alice Maraschini, Gabriella Badoni, National Center for Epidemiology, Surveillance and Health Promotion-ISS; Corrado Tamburino, Marco Barbanti, SICI-GISE, Gennaro Santoro, FIC, ANMCO; Francesco Santini, Francesco Onorati, Claudio Grossi, SICCH; Marco Ranucci, Remo Daniel Covello, ITACTA; Danilo Fusco, Epidemiology Department Lazio Region; Rossana De Palma, Emilia Romagna Region; Salvatore Scondotto, Sicilia Region.

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Authors and Affiliations

  1. Department of Surgery, Oulu University Hospital, Oulu, Finland

    Fausto Biancari

  2. National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy

    Paola D’Errigo, Stefano Rosato & Fulvia Seccareccia

  3. First Faculty of Medicine, Institute of Anatomy, Charles University in Prague, Prague, Czech Republic

    Marek Pol

  4. Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy

    Corrado Tamburino

  5. Department of Cardiothoracic and Vascular Anesthesia, ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Marco Ranucci

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  1. Fausto Biancari
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  2. Paola D’Errigo
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  3. Stefano Rosato
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  5. Corrado Tamburino
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  7. Fulvia Seccareccia
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Correspondence to Paola D’Errigo.

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Conflict of interest

Prof. Tamburino receives honorary fees from Medtronic and Abbott; there is no potential conflict of interest related to the matter of the article for any other author.

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On behalf of the OBSERVANT Research Group.

Members of OBSERVANT Research Group are listed in Acknowledgements.

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Biancari, F., D’Errigo, P., Rosato, S. et al. Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature. Heart Vessels 32, 157–165 (2017). https://doi.org/10.1007/s00380-016-0857-3

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