Age-Related 2-Year Mortality After Transcatheter Aortic Valve Replacement: the YOUNG TAVR Registry |
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| Institution: | 1. Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy;2. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;3. Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland;4. Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University Medical School, Rome, Italy;5. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland;6. Department of Cardiology, Charité-Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), University Heart Center, Berlin, Germany;7. Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany;8. Department of Cardiology, Azienda Usl Toscana Nord-Ovest Cardiologia UTIC ed Emodinamica-Ospedali Riuniti di Livorno, Italy;9. Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy;10. INOVA Heart and Vascular Institute, Fairfax, VA;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN;2. Resident in Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Rochester, MN;3. Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN;1. Cleveland Clinic, Cleveland, OH, USA;2. Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA;3. Cedars Sinai Medical Center, Los Angeles, CA, USA;4. St Paul''s Hospital, Vancouver, BC, Canada;5. Baylor Scott & White Health, Plano, TX, USA;6. Duke Clinical Research Institute/Duke University Medical Center, Durham, NC, USA;7. Emory University School of Medicine, Atlanta, GA, USA;8. University of Pennsylvania, Philadelphia, PA, USA;9. Medstar Washington Hospital Center, Washington, DC, USA;10. NYU Langone Medical Center, New York, NY, USA;11. Lenox Hill Hospital, New York, NY, USA;12. Stanford University School of Medicine, Department of Cardiovascular Surgery, Falk CV Research Center, Stanford, CA, USA;13. independent consultant, Lake Forest, CA, USA;1. Emory University, Atlanta, Georgia;2. Columbia University Medical Center, New York, New York;3. Cleveland Clinic, Cleveland, Ohio;4. University of Washington, Seattle, Washington;5. New York University, Langone Medical Center, New York, New York;6. Cedars-Sinai Medical Center, Los Angeles, California;7. Saint Luke’s Mid-America Heart Institute, Kansas City, Missouri;8. MedStar Washington Hospital Center, Washington, District of Columbia;9. University of Pennsylvania Health System, Philadelphia, Pennsylvania;10. University of Virginia Health System, Charlottesville, Virginia;11. Washington University, St. Louis, Missouri;12. Baylor, Scott & White Health, Plano, Texas;1. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;2. Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts |
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| Abstract: | ObjectiveTo comparatively assess the natural history of patients of different ages undergoing transcatheter aortic valve replacement (TAVR).Patients and MethodsFor this study, we used the YOUNG TAVR, an international, multicenter registry investigating mortality trends up to 2 years in patients with aortic valve stenosis treated by TAVR, classified according to 3 prespecified age groups: 75 years or younger (n=179), 76 to 86 years (n=602), and older than 86 years (n=221). A total of 1002 patients undergoing TAVR were included. Demographic, clinical, and outcome data in the youngest group were compared with those of patients 76 to 86 years and older than 86 years. Patients were followed up for up to 2 years.ResultsCompared with patients 75 years or younger (reference group), patients aged 76 to 86 years and older than 86 years had nonsignificantly different 30-day mortality (odds ratio, 0.76; 95% CI, 0.41-1.38; P=.37 and odds ratio, 1.27; 95% CI, 0.62-2.60; P=.51, respectively) and 1-year mortality (hazard ratio (HR), 0.72; 95% CI, 0.48-1.09; P=.12 and HR, 1.11; 95% CI, 0.88-1.40; P=.34, respectively). Mortality at 2 years was significantly lower among patients aged 76 to 86 years (HR, 0.62; 95% CI, 0.42-0.90; P=.01) but not among the older group (HR, 1.06; 95% CI, 0.68-1.67; P=.79). The Society of Thoracic Surgeons 30-day mortality score was lower in younger patients who, however, had a significantly higher prevalence of chronic obstructive pulmonary disease (P=.005 vs the intermediate group and P=.02 vs the older group) and bicuspid aortic valves (P=.02 vs both older groups), larger left ventricles, and lower ejection fractions.ConclusionIn the present registry, mortality at 2 years after TAVR among patients 75 years or younger was higher compared with that of patients aged 75 to 86 years and was not markedly different from that of patients older than 86 years. The findings are attributable at least in part to a greater burden of comorbidities in the younger age group that are not entirely captured by current risk assessment tools. |
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