Journal article
Temporal Trends and Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians
Journal of the American Heart Association, Vol.8(21), pp.e013685-e013685
11/05/2019
DOI: 10.1161/JAHA.119.013685
PMCID: PMC6898796
PMID: 31668118
Abstract
Background Contemporary outcomes of transcatheter aortic valve replacement (TAVR) in nonagenarians are unknown. Methods and Results We identified 13 544 nonagenarians (aged 90-100 years) who underwent TAVR between 2012 and 2016 using Medicare claims. Generalized estimating equations were used to study the change in short-term outcomes among nonagenarians over time. We compared outcomes between nonagenarians and non-nonagenarians undergoing TAVR in 2016. A mixed-effect multivariable logistic regression was performed to determine predictors of 30-day mortality in nonagenarians in 2016. A center was defined as a
if it performed ≥100 TAVR procedures per year. After adjusting for changes in patients' characteristics, risk-adjusted 30-day mortality declined in nonagenarians from 9.8% in 2012 to 4.4% in 2016 (
<0.001), whereas mortality for patients <90 years decreased from 6.4% to 3.5%. In 2016, 35 712 TAVR procedures were performed, of which 12.7% were in nonagenarians. Overall, in-hospital mortality in 2016 was higher in nonagenarians compared with younger patients (2.4% versus 1.7%,
<0.05) but did not differ in analysis limited to high-volume centers (2.2% versus 1.7%; odds ratio: 1.33; 95% CI, 0.97-1.81;
=0.07). Important predictors of 30-day mortality in nonagenarians included in-hospital stroke (adjusted odds ratio [aOR]: 8.67; 95% CI, 5.03-15.00), acute kidney injury (aOR: 4.11; 95% CI, 2.90-5.83), blood transfusion (aOR: 2.66; 95% CI, 1.81-3.90), respiratory complications (aOR: 2.96; 95% CI, 1.52-5.76), heart failure (aOR: 1.86; 95% CI, 1.04-3.34), coagulopathy (aOR: 1.59; 95% CI, 1.12-2.26;
<0.05 for all). Conclusions Short-term outcomes after TAVR have improved in nonagenarians. Several procedural complications were associated with increased 30-day mortality among nonagenarians.
Details
- Title: Subtitle
- Temporal Trends and Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians
- Creators
- Amgad Mentias - University of IowaMarwan Saad - Brown UniversityMilind Y Desai - Cleveland ClinicPhillip A Horwitz - University of IowaJames D Rossen - University of IowaSidakpal Panaich - University of IowaAyman Elbadawi - The University of Texas Medical Branch at GalvestonAbdul Qazi - Roy J. and Lucille A. Carver College of MedicinePaul Sorajja - Abbott Northwestern HospitalHani Jneid - Baylor College of MedicineSamir Kapadia - Cleveland ClinicBarry London - University of IowaMary S Vaughan Sarrazin - Iowa City VA Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.8(21), pp.e013685-e013685
- DOI
- 10.1161/JAHA.119.013685
- PMID
- 31668118
- PMCID
- PMC6898796
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Grant note
- T32 HL007121 / NHLBI NIH HHS R01 AG055663 / NIA NIH HHS
- Language
- English
- Date published
- 11/05/2019
- Academic Unit
- Neurology; Molecular Physiology and Biophysics; Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984297598302771
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