Universität zu Köln

Blumenstein, J., Moellmann, H., Bleiziffer, S., Bauer, T., Ensminger, S., Bekeredjian, R., Walther, T., Frerker, C., Beyersdorf, F., Hamm, C. and Beckmann, A. (2020). Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY). Clin. Res. Cardiol., 109 (9). S. 1099 - 1107. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

Objective The aim of this study was to compare the outcome of nonagenarians (>= 90 years) with that of younger (< 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice. Methods Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients. Results Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p < 0.001), frail (38.7% vs. 34.7%, p < 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p < 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p > 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age >= 90 years could be identified as an isolated risk factor for mortality. Conclusion TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients-most probably due to the intrinsic higher risk profile of the very old patients-the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Blumenstein, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Moellmann, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bleiziffer, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bauer, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ensminger, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bekeredjian, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Walther, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Frerker, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Beyersdorf, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamm, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Beckmann, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-348133
DOI:	10.1007/s00392-020-01601-4
Journal or Publication Title:	Clin. Res. Cardiol.
Volume:	109
Number:	9
Page Range:	S. 1099 - 1107
Date:	2020
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PERMANENT PACEMAKER IMPLANTATION; QUALITY-OF-LIFE; GREATER-THAN-OR-EQUAL-TO-90 YEARS; CONSENSUS DOCUMENT; REPLACEMENT; OUTCOMES; PREDICTORS; ANESTHESIA; STENOSIS; MORTALITY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34813