Transcatheter Aortic Valve Implantation in Nonagenarians: In-Hospital Complications and One-Year Follow-Up Mortality

Abstract

Background:

Aortic Stenosis (AS) is prevalent among elderly individuals and is associated with high mortality when untreated. Transcatheter Aortic Valve Implantation (TAVI) has emerged as a viable therapeutic alternative, particularly for patients with surgical contraindications. However, its application in nonagenarians remains controversial due to limited data in this very elderly population.

Objective:

To evaluate clinical outcomes in nonagenarian patients undergoing TAVI at a private quaternary hospital, with emphasis on mortality and in-hospital as well as one-year complications.

Methods:

A retrospective cohort study with prospective follow-up was conducted between 2009 and 2023. A total of 265 patients with symptomatic severe AS who underwent TAVI were included, of whom 40 were nonagenarians (≥ 89 years). Data were obtained from an institutional database and from the Brazilian Registry of Aortic Bioprosthesis Implantation by Catheter – New Technologies (RIBAC-NT). Comparisons between nonagenarians and younger patients were performed using the Student’s t-test for continuous variables and the chi-square (χ²) test for categorical variables. A p-value < 0.05 was considered statistically significant.

Results:

Among nonagenarians, 55% were female, 72.5% had hypertension, and 95% had chronic kidney disease. The technical success rate was 55%. Major complications included permanent pacemaker implantation (35%) and adverse events (45%). In-hospital mortality was 7.9%, with no statistically significant differences at 30 days (p = 0.40), 6 months (p = 0.35), and one year (p = 0.06) compared to younger patients.

Conclusion:

TAVI proved to be a safe and effective therapeutic option in nonagenarians, showing clinical outcomes comparable to those of younger individuals.