SPC365

Transcatheter aortic valve implantation in very old patients: a single-centre experience

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Mariana Ribeiro Silva

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Posters
FP Number: ---
Authors: Mariana Ribeiro Da Silva; Gualter Santos Silva; Pedro Ribeiro Queirós; Mariana Brandão; Diogo Santos Ferreira; Cláudio Guerreiro; Adelaide Dias; Daniel Caeiro; Olga Sousa; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">Transcatheter aortic valve implantation (TAVI) is a well-established alternative<strong> </strong>to surgery for the treatment of patients (pts) with severe aortic stenosis at all ranges of surgical risk. The number of very old pts with severe aortic stenosis treated with TAVI is growing. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Objectives</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">: To compare the outcome of very old (&ge; 85 years) with that of younger (&lt;85 years) pts undergoing TAVI in common practice.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">Retrospective study of all pts submitted to TAVI between 2010 and 2018. Data were analyzed </span><span style="background-color:white"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#212121">regarding procedural outcome, 30-day, and 1-year outcomes of very-old compared to younger pts.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results and Discussion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">We included 545 pts, 274 were female (50,3%), mean age of 79,6 years, and mean STS of 5,3. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Between that period of time, 153 pts had &ge;85 years (28,1%). Very old pts were significantly more often female (64,1% vs 44,9%, p&lt;0,001) and had more often chronic kidney disease (78,4% vs 55,9%, p&lt;0,001). Younger pts had more often <em>Diabetes mellitus </em>(44,6% vs 19,6%, p&lt;0,001), and were more often active smokers (19,8% vs 4,9%, p&lt;0,001). Also, younger pts had significantly more frequently coronary disease (77,9% vs 45,1%, p=0,01), previous coronary artery bypass graft surgery (18,7% vs 7,8%, p=0,001), previous cardiac surgery (23,0% vs 9,8%, p=0,002), peripheral artery disease (12,8% vs 4,5%, p=0,007) and cancer (16,9% vs 8,3%, p=0,020). Most very old pts were refused for aortic valve replacement surgery due to high surgical risk (75,9% vs 57,4%, p&lt;0,001), with a higher mean STS (6,3 vs 4,9, p&lt;0,001). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">No significant differences were observed regarding technical aspects of the procedure between groups. During periprocedural period, very old pts had higher frequency of acute kidney injury (AKI) (21,6% vs 17,3%, p=0,036), without significant differences in minor or major hemorrhage, need for blood transfusion, vascular complications (major or minor), cerebrovascular complications, need for permanent pacemaker implantation, new-onset of left bundle brunch block or atrial fibrillation. No significant differences were found in the rates of respiratory tract infections, the need for invasive mechanical ventilation or cardiogenic shock during hospital stay. The number of days in the intensive cardiac care unit and in general ward were comparable between both groups. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Periprocedural (0,8% vs 2,6%), 30-day (2,7% vs 4,5%) and 1-year (13,1% vs 12,6%) mortality rates were equivalent between very-old and younger pts (p&gt;0,05 for all).</span></span></span></span></p>

<p><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">TAVI is a highly standardized procedure with increasing clinical applicability, including pts across all surgical risk spectrum and all ages. Although older pts usually have higher surgical risk, this study showed that, for our population, TAVI presents a very acceptable safety profile even in very old pts, maintaining a high procedural success. In older pts, attention should be paid to kidney function due to increased risk of AKI. </span></span></p>