Medical Research: What is the background for this study?
Dr. Abramowitz: The number of elderly patients with severe symptomatic aortic stenosis (AS) that require aortic valve replacement has been significantly increasing in recent years. However, a decade ago, third of the patients were not referred to surgery, in particular because of advanced age, and /or multiple comorbidities. TAVR has emerged as a treatment option for elderly inoperable or high-risk surgical patients with severe aortic stenosis. There is scarce evidence on the feasibility and safety of TAVR in very old patients.
Medical Research: What are the main findings?
Dr. Abramowitz: We compared 136 patients that were at least 90 years old at the time of TAVR (mean age: 92.4years) to 598 younger patients (mean age: 79.7years). Device success was excellent in both groups (96% for both). All-cause mortality at 30-days and 1-year was 2.9% and 12.5% vs. 2.8% and 12.3% in patients aged ≥ 90 and ˂ 90, respectively. All major complication rates were similar between groups.
Medical Research: What should clinicians and patients take away from your report?
Dr. Abramowitz: The main message of this study is that advanced age, in the absence of significant comorbidities, should not deter clinicians from offering TAVR for patients with severe aortic stenosis. When considering candidates for TAVR, it is very important to comprehensively assess the patient based on cognitive function, mobility, comorbidities and also to consider technical procedure-related features such as access site characteristics. The decision to perform TAVR should be based on all of these considerations – with advanced age being one out of many factors influencing the final decision.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Abramowitz: Future studies are needed to evaluate the true influence of TAVR on longer term mortality and on the change in quality of life following TAVR in extremely elderly patients.
Yigal Abramowitz, MD (2015). Comorbidities Rather Than Age Should Guide TAVR Decision In Elderly With Aortic Stenosis