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Decage News - 004 (Julho/2018)
Short- and long-term clinical outcomes in nonagenarian patients undergoing transcatheter aortic valve implantation
Izo Helber- SP
Este estudo observacional do "mundo real" de mais de 800 pacientes do Registro Brasileiro tratados com implante transcateter valvar aórtica (TAVI) durante 7 anos, mostrou que os nonagenários (10,2%), apresentaram quase o dobro do risco de morte por todas as causas nos primeiros 30 dias, porém as taxas de acidente vascular cerebral, morte por todas as causas e eventos cardíacos adversos maiores (MACE) foram quase idênticos em 2 anos.
Embora uma análise de qualidade de vida não tivesse sido objeto deste estudo, após 2 anos de seguimento a maioria dos pacientes nonagenário apresentavam-se em classe funcional I ou II da classificação da NYHA.
Estes novos dados devem ajudar a aliviar as preocupações sobre o tratamento de pacientes idosos de alto risco. Isso é particularmente importante à medida que o TAVI se expande e a demografia mundial muda, uma combinação que significa que os médicos provavelmente terão cada vez mais que cuidar de pacientes significativamente mais idosos com estenose aórtica.
I. HYPERLINK "javascript:;"Helber, L.F. Guimaraes, L.A. Carvalho, A. Abizaid, R.S. Leite, A.S. HYPERLINK "javascript:;"Colafranceschi,M.C. Ferreira ,E. HYPERLINK "javascript:;"Guerios, A. Dourado, F.S. Brito ,A. Caixeta
European Heart Journal, Volume 38, Issue suppl_1, 1 August 2017,
Cite this article: Nonagenarians 'Good Candidates' for TAVI Surgery - Medscape - Sep 01, 2017.
Cite this article: Nonagenarians Fare Well After TAVR, Once They Get Beyond 30 Days- TCTMD - tctmd.com / By Michael HYPERLINK "https://www.tctmd.com/staff/michael-oriordan"O'Riordan August 31, 2017
Background: Transcatheter aortic valve implantation (TAVI) has been established as a standard treatment in inoperable and high-risk elderly patients with severe aortic stenosis. There is a debate about clinical utility of TAVI in some very high-risk subgroups of patients, including those >90 years old. However, there is few data assessing the safety and the efficacy of TAVI in patients older than 90 years. We aimed to assess the early and long-term clinical outcomes in nonagenarian patients undergoing TAVI.
Methods: Between January 2008 and February 2015, patients with symptomatic severe aortic stenosis underwent and were enrolled in the Brazilian multicenter registry. Among a total of 819 patients, 735 were <90 years and 84 (10.2%) were nonagenarian. Kaplan-Meier estimates of all-cause mortality is shown in Figure.
Results: Nonagenarian patients were 12 years older than pts <90 years (92.4 years vs. 80.1 years; p<0.001). Compared with pts <90 years, nonagenarian patients had higher STS risk score (13.19% vs. 9.87%; p<0.001), lower body mass index (24.61±3.87 vs. 26.49±4.78 kg/m2; p=0.001). At 30 days the rate of all-cause mortality was higher in nonagenarian group (15.6% vs. 8.4%; p=0.04) with similar rates of death at 1-year (20.9% vs. 21.8%). After 2-year of follow-up there was also a higher event rate in nonagenarian patients.
Conclusions: In this real world large-scale observational study, nonagenarian patients who underwent TAVI had worse short-term outcomes but similar long-term clinical outcomes as compared with patients <90 years. Therefore, TAVI for nonagenarian patients with severe aortic stenosis cannot be considered a futile treatment.
