Adrian Attinger-Toller1, Enrico Ferrari2, David Tueller3, Christian Templin4, Olivier Muller5, Fabian Nietlispach6, Stefan Toggweiler7, Stéphane Noble8, Marco Roffi8, Raban Jeger9, Christoph Huber10, Thierry Carrel11, Thomas Pilgrim12, Peter Wenaweser13, Mario Togni14, Stéphane Cook14, Dik Heg15, Stephan Windecker12, Jean-Jacques Goy14, Stefan Stortecky12. 1. Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland. Electronic address: adrian.attinger@bluewin.ch. 2. Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland; University Heart Center, Zurich, Switzerland. 3. Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland. 4. Department of Cardiology, University Heart Center, Zurich, Switzerland. 5. Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. 6. Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland. 7. Department of Cardiology, Cantonal Hospital, Luzern, Switzerland. 8. Department of Cardiology, Geneva University Hospital, Geneva, Switzerland. 9. Department of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland. 10. Department of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland. 11. Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland. 12. Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland. 13. Department of Cardiology, Heart Clinic Hirslanden, Zurich, Switzerland. 14. Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland; Department of Cardiology, Hirslanden Clinique Cecil, Lausanne, Switzerland. 15. CTU Bern, University of Bern, Bern, Switzerland.
Abstract
OBJECTIVES: The 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. BACKGROUND: TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups. METHODS: Data 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. RESULTS: Between 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. CONCLUSIONS: Increasing 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).
OBJECTIVES: The 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. BACKGROUND: TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups. METHODS: Data 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. RESULTS: Between 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. CONCLUSIONS: Increasing 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).
Authors: Parth P Patel; Abdallah El Sabbagh; Patrick W Johnson; Rayan Suliman; Najiyah Salwa; Andrea Carolina Morales-Lara; Peter Pollak; Mohamad Yamani; Pragnesh Parikh; Sushilkumar K Sonavane; Carolyn Landolfo; Mohamad Adnan Alkhouli; Mackram F Eleid; Mayra Guerrero; F David Fortuin; John Sweeney; Peter A Noseworthy; Rickey E Carter; Demilade Adedinsewo Journal: Circ Cardiovasc Imaging Date: 2022-08-03 Impact factor: 8.589