Clinical and Functional Outcomes Associated with Age After Non-Transfemoral Transcatheter Aortic Valve Replacement
Alexis K. Okoh, Molly Schultheis, Sari Kaplon, Ravindra K. Karanam, Margarita T. Camacho, Mark Russo, RWJ Barnabas Health, Newark, New Jersey, USA
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) via a non-transfemoral (TF) approach is associated with high morbidity in advanced age patients. The aim of this study is to investigate the association of age and clinical and functional outcomes after non-TF TAVR.
METHODS: Non-TF TAVR patients were divided into three age groups: <75 years (Group I), 75-85 years (Group II), and >85 years (Group III). Pre-and post-operative clinical, functional status and procedure-related outcomes were compared among patient groups. A multivariable Cox proportional hazards model was used to assess the impact of age on overall all-cause mortality.
RESULTS: A total of 154 patients including 21 aged <75 (Group I), 69 aged 75-85 (Group II) and 64 aged >85 years (Group III) were studied. Short term (30-day) clinical and functional status improved significantly for all age groups. The incidence of acute kidney injury (AKI), access site complications (ASC) and the requirement for permanent pacemaker (PPM) were similar for all age groups at 30-days. After a median follow-up of 17 months, overall all-cause mortality rates were 14% for group I, 26% for group II and 36% for group III (p=0.135). A Cox proportional hazards model showed frailty statu (HR:1.84 95% Confidence Interval (1.23, 2.69); p=0.003) but not age as an independent predictor of overall all-cause mortality.
CONCLUSIONS: Both older and younger patients benefit from non-TF TAVR with comparable outcomes. Postoperative morbidity and mortality rates are similar across different non-TF TAVR age groups. Age should not be an exclusion criterion for non-TF TAVR.