Morbidity and mortality of nonagenarians undergoing CoreValve implantationReport as inadecuate




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BMC Cardiovascular Disorders

, 12:80

Non-coronary artery cardiac disease

Abstract

BackgroundNonagenarians are mostly denied from different therapeutic strategies due to high comorbidity index and risk-benefit calculation. We present the results of nonagenarians with high comorbidity index not eligible for conventional aortic valve surgery undergoing transcatheter aortic valve implantation TAVI with the CoreValve system.

MethodsOur retrospective analysis include baseline parameters, procedural characteristics, morbidity, mortality as well as twelve-lead surface ECG and echocardiographic parameters which were revealed preinterventionally, at hospital discharge and at 30-day follow-up. Clinical follow-up was performed 6 months after TAVI.

ResultsOut of 158 patients 11 nonagenarians with a mean age of 92.6 ± 1.3 years suffering from severe aortic valve stenosis and elevated comorbidity index logistic EuroSCORE of 32.0 ± 9.5%, STS score 25.3 ± 9.7% underwent TAVI between January 2008 and January 2011 using the third-generation percutaneous self-expanding CoreValve prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area AVA of 0.6 ± 0.2 cm with a mean and peak pressure gradient of 60.2 ± 13.1mmHg and 91.0 ± 27.4mmHg, respectively. The 30-day follow up all cause and cardiovascular mortality was 27.3% and 9.1%, respectively. One major stroke 9.1%, 2 pulmonary embolisms 18.2%, 1 periprocedural 9.1% and 1 9.1% spontaneous myocardial infarction occured. Life-threatening or disabling bleeding occurred in 2 cases 18.2%, and minor bleeding in 7 cases 63.6%. Mean severity of heart failure according to NYHA functional class improved from 3.2 ± 0.8 to 1.36 ± 0.5 while mean AVA increased from 0.6 ± 0.2cm to 1.8 ± 0.2cm. At 6-months follow-up 8 patients 72.7% were alive without any additional myocardial infarction, pulmonary embolism, bleeding, or stroke as compared to 30-day follow-up.

ConclusionOur case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with CoreValve.

KeywordsCoreValve Aortic stenosis Nonagenarian Surgery TAVI AbbreviationsASAortic stenosis

AVAAortic valve area

AVRAortic valve replacement

ECGElectrocardiography

ICUIntensive care unit

NYHANew York Heart Association

PCIPercutaneous coronary intervention

TAVITranscatheter aortic valve implantation.

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Author: Ibrahim Akin - Stephan Kische - Lylia Paranskaya - Henrik Schneider - Tim C Rehders - Gökmen R Turan - Dimitar Divchev -

Source: https://link.springer.com/article/10.1186/1471-2261-12-80







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