In-hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Authors

Islam Y. Elgendy, Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida.
Ahmed N. Mahmoud, Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida.
Ayman Elbadawi, Rochester Regional HealthFollow
Akram Y. Elgendy, Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida.
Mohamed A. Omer, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
Michael Megaly, Division of Cardiovascular Medicine, Minneapolis Heart Institute, Abbot Northwestern Hospital, Minneapolis, Minnesota.
Mohammad K. Mojadidi, Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia.
Hani Jneid, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas.

Department

Medicine

Document Type

Article

Publication Title

Catheterization And Cardiovascular Interventions

Abstract

OBJECTIVES: To compare the in-hospital outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in nonagenarians. BACKGROUND: Data comparing the outcomes of TAVR versus SAVR in nonagenarians are limited. METHODS: Using the National Inpatient Sample years 2012-2014, hospitalization data were retrieved for subjects aged ≥90 years who underwent TAVR or SAVR for severe aortic stenosis. The incidence of in-hospital mortality and peri-procedural outcomes were compared using unadjusted, multivariate logistic regression, and propensity score matched analyses. RESULTS: The final cohort included 6,680 records of nonagenarians undergoing aortic valve replacement, among which 5,840 (87.4%) underwent TAVR. There was no difference in the incidence of in-hospital mortality between both groups in the unadjusted (5.8% versus 6.0% P = 0.95), multivariate (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35-1.74), and propensity score matched (OR 1.07, 95% CI 0.75-1.51) analyses. In the propensity-matched analysis, TAVR was associated with a lower incidence of acute kidney injury (OR 0.58, 95% CI 0.47-0.72), post-operative blood transfusion (OR 0.51, 95% CI 0.43-0.61), a higher likelihood of discharge to home (OR 4.71, 95% 3.44-5.06), and a similar incidence of pacemaker placement (OR 1.16, 95% 0.89-1.53) and stroke (OR 1.34, 0.90-1.99). CONCLUSIONS: In this nationwide analysis, TAVR was associated with an overall similar incidence of in-hospital mortality and less morbidity compared with SAVR. These findings suggest that TAVR is effective and safe in nonagenarians.

First Page

989

Last Page

995

DOI

10.1002/ccd.28050

Volume

93

Issue

5

Publication Date

4-1-2019

Medical Subject Headings

Age Factors; Aged, 80 and over; Aortic Valve (diagnostic imaging, physiopathology, surgery); Aortic Valve Stenosis (diagnostic imaging, mortality, physiopathology, surgery); Comparative Effectiveness Research; Databases, Factual; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation (adverse effects, instrumentation, mortality); Hospital Mortality; Humans; Incidence; Male; Postoperative Complications (mortality, therapy); Risk Assessment; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement (adverse effects, instrumentation, mortality); Treatment Outcome; United States (epidemiology)

PubMed ID

30569661

Recommended Citation

Elgendy, I. Y., Mahmoud, A. N., Elbadawi, A., Elgendy, A. Y., Omer, M. A., Megaly, M., Mojadidi, M. K., & Jneid, H. (2019). In-hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians. Catheterization And Cardiovascular Interventions, 93 (5), 989-995. https://doi.org/10.1002/ccd.28050