The following is a summary of “Outcomes of Transcatheter Aortic Valve Implantation in Nonagenarians and Octogenarians (Analysis from the National Inpatient Sample Database),” published in the July 2023 issue of the Cardiovascular Disease by Ismayl et al.

The uncertainties regarding the risks associated with transcatheter aortic valve implantation (TAVI) in nonagenarian (age ≥90 years) and octogenarian (age 80 to 89 years) patients, as compared to clinically similar septuagenarian (age 70 to 79 years) patients, have yet to be clarified. This study aimed to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in individuals aged 90 years and above (nonagenarians) and those aged 80 to 89 years (octogenarians) compared to individuals aged 70 to 79 years (septuagenarians). A retrospective cohort study was performed utilizing the National Inpatient Sample database to ascertain individuals aged ≥70 years who were admitted to the hospital for Transcatheter Aortic Valve Implantation (TAVI) between 2016 and 2020. The objective was to compare the outcomes between nonagenarians and octogenarians versus septuagenarians. The principal product observed was mortality occurring within the hospital setting. 

Secondary outcomes encompass procedural complications, duration of hospitalization (LOS), and overall expenses. The trends in in-patient outcomes were assessed. Results were adjusted for relevant demographic and clinical variables. The entire cohort consisted of 263,325 patients admitted for transcatheter aortic valve implantation (TAVI), with 11.9% individuals in their nineties, 51.1% in their eighties, and 37.0% in their seventies. Following adjustment, individuals in their nineties and eighties exhibited an increased likelihood of in-hospital mortality (adjusted odds ratio 1.80, 95% confidence interval 1.34 to 2.41 for nonagenarians; adjusted odds ratio 1.65, 95% confidence interval 1.35 to 2.01 for octogenarians), heart block, permanent pacemaker insertion, stroke, major bleeding, blood transfusion, and palliative care consultation compared to individuals in their seventies (all P<0.01). 

The length of stay (LOS) was found to be extended, and the overall costs were observed to be elevated for individuals in their nineties and eighties (both P <0.01). During the duration of the study, there was a notable decrease in in-hospital mortality among individuals in their nineties (P^trend = 0.04). Additionally, there were reductions in significant bleeding, permanent pacemaker insertion, length of stay (LOS), and costs for all patients aged 70 years and older (P^trend <0.01). In summary, individuals in their nineties and eighties who underwent transcatheter aortic valve implantation (TAVI) exhibit elevated rates of mortality and complications associated with the procedure compared to septuagenarians who are clinically similar. Additional investigation is required to enhance results in this vulnerable population.

Source: sciencedirect.com/science/article/abs/pii/S0002914923002758