Age-Related Outcomes After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry |
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| Authors: | Adrian Attinger-Toller Enrico Ferrari David Tueller Christian Templin Olivier Muller Fabian Nietlispach Stefan Toggweiler Stéphane Noble Marco Roffi Raban Jeger Christoph Huber Thierry Carrel Thomas Pilgrim Peter Wenaweser Mario Togni Stéphane Cook Dik Heg Stephan Windecker Stefan Stortecky |
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| Institution: | 1. Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland;2. Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland;3. University Heart Center, Zurich, Switzerland;4. Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland;5. Department of Cardiology, University Heart Center, Zurich, Switzerland;6. Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland;7. Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland;8. Department of Cardiology, Cantonal Hospital, Luzern, Switzerland;9. Department of Cardiology, Geneva University Hospital, Geneva, Switzerland;10. Department of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland;11. Department of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland;12. Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland;13. Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland;14. Department of Cardiology, Heart Clinic Hirslanden, Zurich, Switzerland;15. Department of Cardiology, Hirslanden Clinique Cecil, Lausanne, Switzerland;p. CTU Bern, University of Bern, Bern, Switzerland |
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| Abstract: | ObjectivesThe aim of this study was to investigate age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study.BackgroundTAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups.MethodsData from the SwissTAVI Registry were analyzed. Clinical outcomes were compared between patients 70 years of age or younger (n = 324), 70 to 79 years of age (n = 1,913), 80 to 89 years of age (n = 4,353), and older than 90 years of age (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios.ResultsBetween February 2011 and June 2018, 7,097 patients (mean age 82.0 ± 6.4 years, 49.6% women) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio HRadj]: 1.45; 95% confidence interval CI]: 1.18 to 1.77; 1-year HRadj: 1.12; 95% CI: 1.01 to 1.24), cerebrovascular accidents (30-day HRadj: 1.35; 95% CI: 1.09 to 1.66; 1-year HRadj: 1.21; 95% CI: 1.02 to 1.45), and pacemaker implantation (30-day HRadj: 1.23; 95% CI: 1.12 to 1.34; 1-year HRadj: 1.19; 95% CI: 1.09 to 1.30) was observed with increasing age. Furthermore, standardized mortality ratios were 12.63 (95% CI: 9.06 to 17.58), 4.09 (95% CI: 3.56 to 4.74), 1.63 (95% CI: 1.50 to 1.78), and 0.93 (95% CI: 0.76 to 1.14) for TAVR patients in relation to the Swiss population <70, 70 to 79, 80 to 89 and ≥90 years of age, respectively.ConclusionsIncreasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer-term follow-up after TAVR. Standardized mortality ratios were higher for TAVR patients younger than 90 years of age compared with expected rates of mortality in an age- and sex-matched Swiss population. (SWISS TAVI Registry; NCT01368250) |
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| Keywords: | age aortic stenosis transcatheter aortic valve replacement ACC"} {"#name":"keyword" "$":{"id":"kwrd0030"} "$$":[{"#name":"text" "_":"American College of Cardiology CI"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"confidence interval HR"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"hazard ratio adjusted hazard ratio OR"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"odds ratio PROM"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"Predicted Risk of Mortality SMR"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"standardized mortality ratio STS"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"Society of Thoracic Surgeons TAVR"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"transcatheter aortic valve replacement |
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