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Mayo Clin Proc. 2019 Feb 26. pii: S0025-6196(19)30044-8. doi: 10.1016/j.mayocp.2019.01.008. [Epub ahead of print]

Age-Related 2-Year Mortality After Transcatheter Aortic Valve Replacement: the Young TAVR Registry.

Author information

1
Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. Electronic address: elianonavarese@gmail.com.
2
Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University Medical School, Rome, Italy.
3
Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
4
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
5
Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; Department of Cardiology, Charité-Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), University Heart Center, Berlin, Germany.
6
Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany.
7
Department of Cardiology, Azienda Usl Toscana Nord-Ovest Cardiologia UTIC ed Emodinamica-Ospedali Riuniti di Livorno, Italy.
8
Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy.
9
Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy.
10
INOVA Heart and Vascular Institute, Fairfax, VA; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Abstract

OBJECTIVE:

To comparatively assess the natural history of patients of different ages undergoing transcatheter aortic valve replacement (TAVR).

PATIENTS AND METHODS:

For this study, we used the YOUNG TAVR, an international, multicenter registry investigating mortality trends up to 2 years in patients with aortic valve stenosis treated by TAVR, classified according to 3 prespecified age groups: 75 years or younger (n=179), 76 to 86 years (n=602), and older than 86 years (n=221). A total of 1002 patients undergoing TAVR were included. Demographic, clinical, and outcome data in the youngest group were compared with those of patients 76 to 86 years and older than 86 years. Patients were followed up for up to 2 years.

RESULTS:

Compared with patients 75 years or younger (reference group), patients aged 76 to 86 years and older than 86 years had nonsignificantly different 30-day mortality (odds ratio, 0.76; 95% CI, 0.41-1.38; P=.37 and odds ratio, 1.27; 95% CI, 0.62-2.60; P=.51, respectively) and 1-year mortality (hazard ratio (HR), 0.72; 95% CI, 0.48-1.09; P=.12 and HR, 1.11; 95% CI, 0.88-1.40; P=.34, respectively). Mortality at 2 years was significantly lower among patients aged 76 to 86 years (HR, 0.62; 95% CI, 0.42-0.90; P=.01) but not among the older group (HR, 1.06; 95% CI, 0.68-1.67; P=.79). The Society of Thoracic Surgeons 30-day mortality score was lower in younger patients who, however, had a significantly higher prevalence of chronic obstructive pulmonary disease (P=.005 vs the intermediate group and P=.02 vs the older group) and bicuspid aortic valves (P=.02 vs both older groups), larger left ventricles, and lower ejection fractions.

CONCLUSION:

In the present registry, mortality at 2 years after TAVR among patients 75 years or younger was higher compared with that of patients aged 75 to 86 years and was not markedly different from that of patients older than 86 years. The findings are attributable at least in part to a greater burden of comorbidities in the younger age group that are not entirely captured by current risk assessment tools.

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