The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement
Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the...
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| Veröffentlicht in: | Internal Medicine 2021/02/15, Vol.60(4), pp.517-523 |
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| creator | Saito, Yukihiro Lewis, Erik E. Raval, Amish Gimelli, Giorgio Jacobson, Kurt M. Osaki, Satoru |
| description | Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehospitalization, the New York Heart Association (NYHA) functional class and echocardiographic parameters were compared between patients |
| doi_str_mv | 10.2169/internalmedicine.5047-20 |
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Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehospitalization, the New York Heart Association (NYHA) functional class and echocardiographic parameters were compared between patients <85 years old (n = 290) and ≥85 years old (n = 143). Results The patients ≥85 years old less frequently had a history of coronary artery disease (73.1% vs. 62.2%, p=0.026) and hypertension (87.2% vs. 77.6%, p=0.012) than younger patients. Furthermore, the patients ≥85 years old had moderate-severe mitral regurgitation more frequently (19.3% vs. 28.7%, p=0.037) at baseline than younger patients. There was no significant difference in in-hospital outcomes between the age groups. The 30-day mortality was worse in patients ≥85 years old than in younger ones (0.7% vs. 3.5%, p=0.042). While there was no significant difference in the long-term mortality between the 2 groups, the estimated 1-year mortality from Kaplan-Meier curves were 9.6% in patients <85 years old and 14.9% in patients ≥85 years old. The rate of in-hospital complications, rehospitalization rate, improvement in the NYHA functional class and echocardiographic parameters were comparable between the two groups. Conclusion The outcomes of super-elderly patients after TAVR were acceptable, suggesting that these patients could benefit from TAVR.</description><identifier>ISSN: 0918-2918</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.5047-20</identifier><identifier>PMID: 33028765</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>Aged ; Aged, 80 and over ; Aortic stenosis ; Aortic valve ; Aortic Valve - surgery ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - surgery ; Cardiovascular disease ; Coronary artery ; Heart diseases ; Heart Valve Prosthesis Implantation - adverse effects ; Humans ; Internal medicine ; Mortality ; Original ; Prognosis ; Regurgitation ; Retrospective Studies ; Rheumatic heart disease ; Risk Factors ; severe AS ; Severity of Illness Index ; Stenosis ; TAVR ; Transcatheter Aortic Valve Replacement - adverse effects ; Treatment Outcome</subject><ispartof>Internal Medicine, 2021/02/15, Vol.60(4), pp.517-523</ispartof><rights>2021 by The Japanese Society of Internal Medicine</rights><rights>Copyright Japan Science and Technology Agency 2021</rights><rights>Copyright © 2021 by The Japanese Society of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c609t-e305a3aa49af21d43cdb46abf36f0b14ad919772022ed64c1f45cc7c7254bfa43</citedby><cites>FETCH-LOGICAL-c609t-e305a3aa49af21d43cdb46abf36f0b14ad919772022ed64c1f45cc7c7254bfa43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946496/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946496/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1876,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33028765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saito, Yukihiro</creatorcontrib><creatorcontrib>Lewis, Erik E.</creatorcontrib><creatorcontrib>Raval, Amish</creatorcontrib><creatorcontrib>Gimelli, Giorgio</creatorcontrib><creatorcontrib>Jacobson, Kurt M.</creatorcontrib><creatorcontrib>Osaki, Satoru</creatorcontrib><title>The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehospitalization, the New York Heart Association (NYHA) functional class and echocardiographic parameters were compared between patients <85 years old (n = 290) and ≥85 years old (n = 143). Results The patients ≥85 years old less frequently had a history of coronary artery disease (73.1% vs. 62.2%, p=0.026) and hypertension (87.2% vs. 77.6%, p=0.012) than younger patients. Furthermore, the patients ≥85 years old had moderate-severe mitral regurgitation more frequently (19.3% vs. 28.7%, p=0.037) at baseline than younger patients. There was no significant difference in in-hospital outcomes between the age groups. The 30-day mortality was worse in patients ≥85 years old than in younger ones (0.7% vs. 3.5%, p=0.042). While there was no significant difference in the long-term mortality between the 2 groups, the estimated 1-year mortality from Kaplan-Meier curves were 9.6% in patients <85 years old and 14.9% in patients ≥85 years old. The rate of in-hospital complications, rehospitalization rate, improvement in the NYHA functional class and echocardiographic parameters were comparable between the two groups. Conclusion The outcomes of super-elderly patients after TAVR were acceptable, suggesting that these patients could benefit from TAVR.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiovascular disease</subject><subject>Coronary artery</subject><subject>Heart diseases</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Mortality</subject><subject>Original</subject><subject>Prognosis</subject><subject>Regurgitation</subject><subject>Retrospective Studies</subject><subject>Rheumatic heart disease</subject><subject>Risk Factors</subject><subject>severe AS</subject><subject>Severity of Illness Index</subject><subject>Stenosis</subject><subject>TAVR</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Treatment Outcome</subject><issn>0918-2918</issn><issn>1349-7235</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkdFuFCEUhonR2LX6CobEG2-mMsAwy41J07Rq0mijq7fkDHNmhw0LK7A1fXtnsutG6w2E8J3_HPgIoTW74LXS71womAL4LfbOuoAXDZNtxdkTsqiF1FXLRfOULJiulxWfljPyIucNY2LZav6cnAnB-LJVzYLY1Yj0LsV1iNllGgd67XtM_oHeQXEYSqa_XBnpZUzFWfqt4AGEYZqArhKEbKGMOJ-OzA_w90i_4s6Dxe0U8ZI8G8BnfHXcz8n3m-vV1cfq9suHT1eXt5VVTJcKBWtAAEgNA697KWzfSQXdINTAulpCr2vdtpxxjr2Sth5kY21rW97IbgApzsn7Q-5u300_Y6fWCbzZJbeF9GAiOPPvTXCjWcd702qppFZTwNtjQIo_95iL2bps0XsIGPfZcCk1V1xyMaFvHqGbuJ-VzJRumGBMz9TyQNkUc044nIapmZlNmscmzWzScDaVvv77MafCP-om4PMB2OQCazwBMEvw-H-yYkbOy7HDCbQjJINB_AYXD76u</recordid><startdate>20210215</startdate><enddate>20210215</enddate><creator>Saito, Yukihiro</creator><creator>Lewis, Erik E.</creator><creator>Raval, Amish</creator><creator>Gimelli, Giorgio</creator><creator>Jacobson, Kurt M.</creator><creator>Osaki, Satoru</creator><general>The Japanese Society of Internal Medicine</general><general>Japan Science and Technology Agency</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210215</creationdate><title>The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement</title><author>Saito, Yukihiro ; Lewis, Erik E. ; Raval, Amish ; Gimelli, Giorgio ; Jacobson, Kurt M. ; Osaki, Satoru</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c609t-e305a3aa49af21d43cdb46abf36f0b14ad919772022ed64c1f45cc7c7254bfa43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic stenosis</topic><topic>Aortic valve</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiovascular disease</topic><topic>Coronary artery</topic><topic>Heart diseases</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Mortality</topic><topic>Original</topic><topic>Prognosis</topic><topic>Regurgitation</topic><topic>Retrospective Studies</topic><topic>Rheumatic heart disease</topic><topic>Risk Factors</topic><topic>severe AS</topic><topic>Severity of Illness Index</topic><topic>Stenosis</topic><topic>TAVR</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saito, Yukihiro</creatorcontrib><creatorcontrib>Lewis, Erik E.</creatorcontrib><creatorcontrib>Raval, Amish</creatorcontrib><creatorcontrib>Gimelli, Giorgio</creatorcontrib><creatorcontrib>Jacobson, Kurt M.</creatorcontrib><creatorcontrib>Osaki, Satoru</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Internal Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saito, Yukihiro</au><au>Lewis, Erik E.</au><au>Raval, Amish</au><au>Gimelli, Giorgio</au><au>Jacobson, Kurt M.</au><au>Osaki, Satoru</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement</atitle><jtitle>Internal Medicine</jtitle><addtitle>Intern. Med.</addtitle><date>2021-02-15</date><risdate>2021</risdate><volume>60</volume><issue>4</issue><spage>517</spage><epage>523</epage><pages>517-523</pages><issn>0918-2918</issn><eissn>1349-7235</eissn><abstract>Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehospitalization, the New York Heart Association (NYHA) functional class and echocardiographic parameters were compared between patients <85 years old (n = 290) and ≥85 years old (n = 143). Results The patients ≥85 years old less frequently had a history of coronary artery disease (73.1% vs. 62.2%, p=0.026) and hypertension (87.2% vs. 77.6%, p=0.012) than younger patients. Furthermore, the patients ≥85 years old had moderate-severe mitral regurgitation more frequently (19.3% vs. 28.7%, p=0.037) at baseline than younger patients. There was no significant difference in in-hospital outcomes between the age groups. The 30-day mortality was worse in patients ≥85 years old than in younger ones (0.7% vs. 3.5%, p=0.042). While there was no significant difference in the long-term mortality between the 2 groups, the estimated 1-year mortality from Kaplan-Meier curves were 9.6% in patients <85 years old and 14.9% in patients ≥85 years old. The rate of in-hospital complications, rehospitalization rate, improvement in the NYHA functional class and echocardiographic parameters were comparable between the two groups. Conclusion The outcomes of super-elderly patients after TAVR were acceptable, suggesting that these patients could benefit from TAVR.</abstract><cop>Japan</cop><pub>The Japanese Society of Internal Medicine</pub><pmid>33028765</pmid><doi>10.2169/internalmedicine.5047-20</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic stenosis Aortic valve Aortic Valve - surgery Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - surgery Cardiovascular disease Coronary artery Heart diseases Heart Valve Prosthesis Implantation - adverse effects Humans Internal medicine Mortality Original Prognosis Regurgitation Retrospective Studies Rheumatic heart disease Risk Factors severe AS Severity of Illness Index Stenosis TAVR Transcatheter Aortic Valve Replacement - adverse effects Treatment Outcome |
| title | The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement |
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