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Heart and Vessels

, Volume 32, Issue 2, pp 157–165 | Cite as

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

  • Fausto Biancari
  • Paola D’ErrigoEmail author
  • Stefano Rosato
  • Marek Pol
  • Corrado Tamburino
  • Marco Ranucci
  • Fulvia Seccareccia
Original Article

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.

Keywords

Aortic valve stenosis Transcatheter aortic valve implantation Transcatheter aortic valve replacement TAVI TAVR Nonagenarian 90 years 

Notes

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.

Compliance with ethical standards

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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Copyright information

© Springer Japan 2016

Authors and Affiliations

  • Fausto Biancari
    • 1
  • Paola D’Errigo
    • 2
    Email author
  • Stefano Rosato
    • 2
  • Marek Pol
    • 3
  • Corrado Tamburino
    • 4
  • Marco Ranucci
    • 5
  • Fulvia Seccareccia
    • 2
  1. 1.Department of SurgeryOulu University HospitalOuluFinland
  2. 2.National Center for Epidemiology, Surveillance and Health PromotionIstituto Superiore di SanitàRomeItaly
  3. 3.First Faculty of Medicine, Institute of AnatomyCharles University in PraguePragueCzech Republic
  4. 4.Division of Cardiology, Ferrarotto HospitalUniversity of CataniaCataniaItaly
  5. 5.Department of Cardiothoracic and Vascular AnesthesiaICU-IRCCS Policlinico San DonatoSan Donato MilaneseItaly

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