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Survival in very elderly patients submitted to TAVI compared to the general population
Session:
Sessão de Posters 08 - Intervenção estrutural: TAVI
Speaker:
MIGUEL VAZ ALMEIDA SOBRAL DOMINGUES
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Sobral Domingues; Rita Lima; Mariana Paiva; Samuel Azevedo; Débora Correia; Afonso Oliveira; Sérgio Madeira; João Brito; Pedro Gonçalves; Henrique Gabriel; Manuel Almeida; Rui Teles
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION:</strong> Severe aortic stenosis (AS) is the most common acquired valvular heart disease. Transcatheter aortic valve implantation (TAVI) is indicated as an alternative to surgery in patients (pts) with severe AS above 75yo regardless of surgical risk.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The prevalence of severe AS increases with age. In the very elderly, i.e. > 85yo, the presence of severe AS is often accompanied with important comorbidities and frailty. To improve pts assessment in the heart team, it is essential to characterize the outcomes of previous interventions in this challenging group of patients and that was the goal of the present study. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong> Single-centre retrospective analysis, on prospectively collected data, of consecutive patients ≥85 years old undergoing TAVI between 2015 to 2021. Successful TAVI, major procedural complications and 1-year mortality rates were defined according to the VARC-3 definition. Observed survival was compared to an age-matched population using life expectancy tables available at Instituto Nacional Estatística. Simulated survival curves for the age-matched population were performed using an expected hazard rate of 0.14. This is a conservative approach assuming that mortality rate remains constant in the population during follow-up.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong> 767 TAVIs procedures were performed, and 349 (45%) pts were included in the study. Median age was 87 years [86-89], 60% female (n = 211) with a median Euroscore II of 5% [4-7]. A total of 98 pts (28%) had previous coronary artery disease (CABG, PCI or MI), 300 pts (85%) had chronic kidney disease and 22 pts (6%) had a previous stroke. Median gradient was 49mmHg [42-60] and ejection fraction was 55mmHg [50-56]. 268 pts (77%) underwent an elective TAVI and the remaining 23% were urgent procedures after hospital admission. The transfemoral approach was used in 334 pts (96%) and 258 pts (74%) implanted a self-expanding valve. Median in-hospital time was 6 days [4-11] and most common complications were permanent pacemaker implantation (n=59, 17%) and major access-related complications (n=17, 5%).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">All-cause mortality at 30 days and 1 year were 2.1% (n=7) and 13.1% (n=46), respectively. This compares similarly to the cohort of younger pts (<85y) which presented a 30 day and 1 year mortality of 2.8% and 12.8%, respectively. 35 pts (10%) were readmitted in the first year (vs 7.6% in <85yo, non-significant).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The mean survival time in our cohort was 4.9 years compared to expected 6.2 (figure 1, log-rank < 0.01). The mortality rate at one year was 13% (n = 46) in our cohort compared to expected mortality 14% (n = 50), not statistically significant.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">CONCLUSION:</span></strong><span style="color:black"> In this study, very old patients submitted to TAVI had a 1-year mortality rate similar to age-matched population and a mean survival time of more than 4 years, albeit inferior to an age-matched population.</span></span></span></p>
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