Clinical outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

To compare the risk of procedural complications and mortality after transcatheter aortic valve implantation (TAVI) in nonagenarians (age ≥ 90 years) compared to younger patients (< 90 years). Although TAVI could be considered as a treatment option in nonagenarians, several previous studies have shown conflicting outcomes between nonagenarians and younger patients who underwent TAVI. We conducted a comprehensive literature search through PubMed and EMBASE to investigate the clinical outcomes of nonagenarians after TAVI. The outcomes of interest were short- and long-term mortality and procedural complications. Our study identified 16 observational studies including a total of 179,565 patients (21,674 nonagenarian patients and 157,891 younger patients. Nonagenarians had a significantly higher rate of short- (hazard ratio [HR], 95% confidence interval [CI]: 1.48, 1.38–1.59; P < 0.001) and long-term mortality (HR, 95% CI: 1.34, 1.24–1.44; P < 0.001) than younger patients after TAVI. Furthermore, there were significant differences in major and/or life-threatening bleeding (risk ratio [RR], 95% CI: 1.21, 1.05–1.39; P = 0.008), stroke (HR, 95% CI: 1.24, 1.11–1.40; P < 0.001), and major vascular complication (RR, 95% CI: 2.15, 1.35–3.42; P = 0.001) between nonagenarians and younger patients after TAVI. Minor vascular complication, myocardial infarction and permanent pacemaker implantation rate were similar between the two groups. Nonagenarians had significantly higher rate of short- and long-term mortality, major and/or life-threatening bleeding, stroke, and major vascular complication after TAVI. Although TAVI is a treatment option in nonagenarians, careful and appropriate selection of patients is essential to improve clinical outcomes.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.

    CAS  Article  Google Scholar 

  2. 2.

    Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.

    CAS  Article  Google Scholar 

  3. 3.

    Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20.

    CAS  Article  Google Scholar 

  4. 4.

    Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376:1321–31.

    Article  Google Scholar 

  5. 5.

    Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705.

    Article  Google Scholar 

  6. 6.

    Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380:1706–15.

    Article  Google Scholar 

  7. 7.

    Ando T, Ashraf S, Villablanca P, et al. Meta-analysis of effectiveness and safety of transcatheter aortic valve implantation versus surgical aortic valve replacement in low-to-intermediate surgical risk cohort. Am J Cardiol. 2019;124:580–5.

    Article  Google Scholar 

  8. 8.

    Asgar AW, Ouzounian M, Adams C, et al. 2019 Canadian cardiovascular society position statement for transcatheter aortic valve implantation. Can J Cardiol. 2019;35:1437–48.

    Article  Google Scholar 

  9. 9.

    Noguchi M, Tabata M, Obunai K, et al. Clinical outcomes of transcatheter aortic valve implantation (TAVI) in nonagenarians from the optimized catheter valvular intervention-TAVI registry. Catheter Cardiovasc Interv. 2020. https://doi.org/10.1002/ccd.28935.

    Article  PubMed  Google Scholar 

  10. 10.

    Stehli J, Koh JQS, Duffy SJ, et al. Comparison of outcomes of transcatheter aortic valve implantation in patients aged >90 years versus <90 years. Am J Cardiol. 2019;124:1085–90.

    Article  Google Scholar 

  11. 11.

    Barth S, Hautmann MB, Reents W, et al. Transcatheter aortic valve replacement for severe aortic stenosis can improve long-term survival of nonagenarians as compared to an age- and sex-matched general population. J Cardiol. 2020;75:134–9.

    Article  Google Scholar 

  12. 12.

    Vlastra W, Chandrasekhar J, Vendrik J, et al. Transfemoral TAVR in nonagenarians: from the CENTER collaboration. JACC Cardiovasc Interv. 2019;12:911–20.

    Article  Google Scholar 

  13. 13.

    Kuno T, Takagi H, Ando T, et al. Short- and long-term outcomes in dialysis patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Can J Cardiol. 2020. https://doi.org/10.1016/j.cjca.2020.01.015.

    Article  PubMed  Google Scholar 

  14. 14.

    Ueyama H, Kuno T, Ando T, et al. Network meta-analysis of surgical aortic valve replacement and different transcatheter heart valve systems for symptomatic severe aortic stenosis. Can J Cardiol. 2020. https://doi.org/10.1016/j.cjca.2020.02.088.

    Article  PubMed  Google Scholar 

  15. 15.

    Leon MB, Piazza N, Nikolsky E, et al. Standardized endpoint definitions for Transcatheter Aortic Valve Implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol. 2011;57:253–69.

    Article  Google Scholar 

  16. 16.

    Kappetein AP, Head SJ, Genereux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60:1438–54.

    Article  Google Scholar 

  17. 17.

    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65-94.

    Article  Google Scholar 

  18. 18.

    ProMeta 3. https://idostatistics.com/prometa3/. Accessed 23 Sep 2020

  19. 19.

    Lin N, Nores MA, James TM, Rothenberg M, Stamou SC. Alternative access transcatheter aortic valve replacement in nonagenarians versus younger patients. Thorac Cardiovasc Surg. 2020. https://doi.org/10.1055/s-0040-1708478.

    Article  PubMed  Google Scholar 

  20. 20.

    Blumenstein J, Möllmann H, Bleiziffer S, et al. Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY). Clin Res Cardiol. 2020. https://doi.org/10.1007/s00392-020-01601-4.

    Article  PubMed  Google Scholar 

  21. 21.

    Deharo P, Bisson A, Herbert J, et al. Outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a nationwide analysis. EuroIntervention. 2020;15:1489–96.

    Article  Google Scholar 

  22. 22.

    Mentias A, Saad M, Desai MY, et al. Temporal trends and clinical outcomes of transcatheter aortic valve replacement in nonagenarians. J Am Heart Assoc. 2019;8:e013685.

    Article  Google Scholar 

  23. 23.

    Yokoyama H, Tobaru T, Muto Y, et al. Long-term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: a multi-center analysis. Clin Cardiol. 2019;42:605–11.

    Article  Google Scholar 

  24. 24.

    Ichimoto E, Arnofsky A, Wilderman M, Goldweit R, De Gregorio J. Early mortality and safety after transcatheter aortic valve replacement using the SAPIEN 3 in nonagenarians. J Geriatr Cardiol. 2018;15:387–93.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Vendrik J, van Mourik MS, van Kesteren F, et al. Comparison of outcomes of transfemoral aortic valve implantation in patients <90 with those >90 years of age. Am J Cardiol. 2018;121:1581–6.

    Article  Google Scholar 

  26. 26.

    Scholtz S, Dimitriadis Z, Vlachojannis M, et al. Transcatheter aortic valve implantation in nonagenarians: procedural outcome and mid-term results. Heart Lung Circ. 2018;27:725–30.

    Article  Google Scholar 

  27. 27.

    McNeely C, Zajarias A, Robbs R, Markwell S, Vassileva CM. Transcatheter aortic valve replacement outcomes in nonagenarians stratified by transfemoral and transapical approach. Ann Thorac Surg. 2017;103:1808–14.

    Article  Google Scholar 

  28. 28.

    Arsalan M, Szerlip M, Vemulapalli S, et al. Should transcatheter aortic valve replacement be performed in nonagenarians? Insights from the STS/ACC TVT registry. J Am Coll Cardiol. 2016;67:1387–95.

    Article  Google Scholar 

  29. 29.

    Escárcega RO, Baker NC, Lipinski MJ, et al. Clinical profiles and correlates of mortality in nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve replacement. Am Heart J. 2016;173:118–25.

    Article  Google Scholar 

  30. 30.

    Abramowitz Y, Chakravarty T, Jilaihawi H, et al. Comparison of outcomes of transcatheter aortic valve implantation in patients ≥90 years versus <90 years. Am J Cardiol. 2015;116:1110–5.

    Article  Google Scholar 

  31. 31.

    Mack MC, Szerlip M, Herbert MA, et al. Outcomes of treatment of nonagenarians with severe aortic stenosis. Ann Thorac Surg. 2015;100:74–80.

    Article  Google Scholar 

  32. 32.

    O’Connor SA, Morice MC, Gilard M, et al. Revisiting sex equality with transcatheter aortic valve replacement outcomes: a collaborative, patient-level meta-analysis of 11,310 patients. J Am Coll Cardiol. 2015;66:221–8.

    Article  Google Scholar 

  33. 33.

    Chandrasekhar J, Dangas G, Yu J, et al. Sex-based differences in outcomes with transcatheter aortic valve therapy: TVT registry from 2011 to 2014. J Am Coll Cardiol. 2016;68:2733–44.

    Article  Google Scholar 

  34. 34.

    Myat A, Buckner L, Mouy F, et al. In-hospital stroke after transcatheter aortic valve implantation: a UK observational cohort analysis. Catheter Cardiovasc Interv. 2020. https://doi.org/10.1002/ccd.29157.

    Article  PubMed  Google Scholar 

  35. 35.

    Aggarwal SK, Delahunty Rn N, Menezes LJ, et al. Patterns of solid particle embolization during transcatheter aortic valve replacement and correlation with aortic valve calcification. J Interv Cardiol. 2018;31:648–54.

    Article  Google Scholar 

  36. 36.

    Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of thoracic surgeons/American college of cardiology TVT registry. JACC Cardiovasc Interv. 2016;9:2189–99.

    Article  Google Scholar 

  37. 37.

    Watanabe Y, Kozuma K, Hioki H, et al. Pre-existing right bundle branch block increases risk for death after transcatheter aortic valve replacement with a balloon-expandable valve. JACC Cardiovasc Interv. 2016;9:2210–6.

    Article  Google Scholar 

  38. 38.

    Kano S, Yamamoto M, Shimura T, et al. Gait speed can predict advanced clinical outcomes in patients who undergo transcatheter aortic valve replacement: insights from a Japanese multicenter registry. Circ Cardiovasc Interv. 2017;10:e005088.

    Article  Google Scholar 

  39. 39.

    Kagase A, Yamamoto M, Shimura T, et al. Sex-specific grip strength after transcatheter aortic valve replacement in elderly patients. JACC Cardiovasc Interv. 2018;11:100–1.

    Article  Google Scholar 

  40. 40.

    Shibata K, Yamamoto M, Kano S, et al. Importance of Geriatric Nutritional Risk Index assessment in patients undergoing transcatheter aortic valve replacement. Am Heart J. 2018;202:68–75.

    Article  Google Scholar 

  41. 41.

    Yamamoto M, Shimura T, Kano S, et al. Prognostic value of hypoalbuminemia after transcatheter aortic valve implantation (from the Japanese multicenter OCEAN-TAVI registry). Am J Cardiol. 2017;119:770–7.

    CAS  Article  Google Scholar 

  42. 42.

    Shimura T, Yamamoto M, Kano S, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation. 2017;135:2013–24.

    Article  Google Scholar 

  43. 43.

    Ministry of Health, Labour and Welfare in Japan. https://www.mhlw.go.jp/toukei/saikin/hw/life/life19/index.html. Accessed 15 Nov 2020

  44. 44.

    Centers for Disease Control and Prevention, National Center for Health Statistics, United States life tables, 2017. National vital statistics reports 68(7). https://www.cdc.gov/nchs/products/life_tables.htm. Accessed 15 Nov 2020

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kuno Toshiki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 4640 KB)

About this article

Verify currency and authenticity via CrossMark

Cite this article

Noguchi, M., Ueyama, H., Ando, T. et al. Clinical outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Cardiovasc Interv and Ther (2021). https://doi.org/10.1007/s12928-021-00755-w

Download citation

Keywords

  • Transcatheter aortic valve implantation
  • Nonagenarians
  • Meta-analysis