Affiliation:
1. Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City IA
2. Cardiovascular Institute The Warren Alpert School of Medicine at Brown University Providence RI
3. Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
4. Division of Cardiovascular Medicine University of Texas Medical Branch Galveston TX
5. Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis MN
6. Division of Cardiology Baylor College of Medicine Houston TX
7. Comprehensive Access and Delivery Research and Evaluation Center (CADRE) Iowa City VA Medical Center Iowa City IA
Abstract
Background
Contemporary outcomes of transcatheter aortic valve replacement (
TAVR
) in nonagenarians are unknown.
Methods and Results
We identified 13 544 nonagenarians (aged 90–100 years) who underwent
TAVR
between 2012 and 2016 using Medicare claims. Generalized estimating equations were used to study the change in short‐term outcomes among nonagenarians over time. We compared outcomes between nonagenarians and non‐nonagenarians undergoing
TAVR
in 2016. A mixed‐effect multivariable logistic regression was performed to determine predictors of 30‐day mortality in nonagenarians in 2016. A center was defined as a
high‐volume center
if it performed ≥100
TAVR
procedures per year. After adjusting for changes in patients’ characteristics, risk‐adjusted 30‐day mortality declined in nonagenarians from 9.8% in 2012 to 4.4% in 2016 (
P
<0.001), whereas mortality for patients <90 years decreased from 6.4% to 3.5%. In 2016, 35 712
TAVR
procedures were performed, of which 12.7% were in nonagenarians. Overall, in‐hospital mortality in 2016 was higher in nonagenarians compared with younger patients (2.4% versus 1.7%,
P
<0.05) but did not differ in analysis limited to high‐volume centers (2.2% versus 1.7%; odds ratio: 1.33; 95%
CI
, 0.97–1.81;
P
=0.07). Important predictors of 30‐day mortality in nonagenarians included in‐hospital stroke (adjusted odds ratio [aOR]: 8.67; 95%
CI
, 5.03–15.00), acute kidney injury (
aOR
: 4.11; 95%
CI
, 2.90–5.83), blood transfusion (
aOR
: 2.66; 95%
CI
, 1.81–3.90), respiratory complications (
aOR
: 2.96; 95%
CI
, 1.52–5.76), heart failure (
aOR
: 1.86; 95%
CI
, 1.04–3.34), coagulopathy (
aOR
: 1.59; 95%
CI
, 1.12–2.26;
P
<0.05 for all).
Conclusions
Short‐term outcomes after
TAVR
have improved in nonagenarians. Several procedural complications were associated with increased 30‐day mortality among nonagenarians.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
17 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献