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INCREASED MORTALITY WITH AGE IN PATIENTS UNDERGOING TAVR
Basel Ramlawi, MD, Walid K. Abu Saleh, MD, Odeaa Al Jabbari, MD, Colin Barker, MD, Chun Lin, MD, Manuel Reyes, MD, Neal Kleiman, MD, Michael J. Reardon, MD.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
OBJECTIVE: The use of transcatheter aortic-valve replacement (TAVR) has been shown to reduce mortality among high-risk patients with aortic stenosis (AS) who are not candidates for surgical replacement. Age is an independent risk factor for surgical aortic valve replacement (SAVR). We analyzed the impact of age on TAVR outcomes.
METHODS: We performed a retrospective analysis of all prospectively collected TAVR data from January 2011 to August 2014 at our institution. A total of 250 patients were analyzed and divided into two main groups according to age (below 80 years old vs. 80 years old or more). Valve Academic Research Consortium 2 (VARC-2) definitions were used. Median numerical value was used. Outcome was calculated from the day of the procedure to the date of death or discharge.
RESULTS: Overall 156/250 patients (62.4%) of TAVR patients were above 80 years old. This group of patients (>80) had a higher median STS predicted risk of mortality (8.0% vs. 5.05%, p<0.001). The older group had a significantly higher mortality compared the younger group (8% vs. 0%; p=0.008). Most of the deaths (6/10) occurred within the first 72 hours. For those, the cause of death (4/6) was due to cardiac arrest, (1/6) due to right ventricular perforation and hypotensive shock, and (1/6) due to cardiogenic shock and respiratory failure. Refer to table for results.
CONCLUSIONS: Like SAVR, advanced age is associated with increased postoperative mortality in TAVR procedures. The majority of these occur within first 72 hours. This has implications on patient selection in relation to overall patient profile. Further larger studies warranted. 
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