595 Impact of age on outcomes in a large multicentre low-to-intermediate risk TAVI population: in and out the age cut-off from ESC 2021 valvular heart disease guidelines
Authors: Sticchi Alessandro , Gallo Francesco , Benenati Stefano , Won-keun Kim , Khokhar Arif A , Zeus Tobias , Toggweiler Stefan , De Marco Federico , Reimers Bernhard , Nombela-franco Luis , Barbanti Marco , Brugaletta Salvatore , Piva Tommaso , Rodes-cabau Josep , Porto Italo , Colombo Antonio , Giannini Francesco 
Published: December 2021

Abstract

Aims
The ESC 2021 valvular heart disease [VHD] guidelines introduced an important and debated age cut-off (75 years) to lead the choice between surgical and transcatheter aortic valve implantation (TAVI) in non-high-risk patients. The aim of this study was to evaluate what impact an age cut-off has on clinical outcomes following TAVI in low-to-Intermediate Risk patients from a real word registry.

Methods
We performed the investigation in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients, comparing the rates of patient risk factors, procedural characteristics, complications, and outcomes in the populations with &lt; or ≥ 75 years old.

Results
In our real-world cohort of 2977 patients with mean STS score of 3.6% (5.0–2.5), we found 301 (10.1%) patients with age &lt;75 years and 2676 (89.9%) with ≥75 years. In the younger group compared with the older, we have a higher prevalence of male (44% vs. 35%, P=0.003), higher BMI (mean of 28.5 kg/m² vs. 26.7 kg/m², P = &lt;0.001), diabetes (32% vs. 26%, P=0.027), insulin-dependent diabetes (12% vs. 7%, P=0.001), smoking (18% vs. 7%, P&lt;0.001), COPD (26% vs. 16%, P&lt;0.001). Moreover, younger patients presented less previous PM/ICD (6% vs. 11%, P=0.023), less atrial fibrillation (24% vs. 33%, P=0.033), less renal impairment (30% vs. 66%, P&lt;0.001) and a lower mean STS score (2.6% vs. 3.7%, P&lt;0.001). There was no difference in annular sizing, valvular and LVOT calcifications between the two groups. Older patients had a higher prevalence of porcelain aorta (2% for age&lt;75 vs. 9%, P=0.001). Between the two groups no significant differences in procedural characteristics were observed, including rates of pre-dilatation (P=0.369), post-dilatation (P=0.159) and contrast volume (P=0.259). Procedural complications, in-hospital outcomes and 2-year Kaplan-Meier (KM) survival was equivalent between both groups (P=0.930). Finally, we assessed the best age cut-off related to 1-year mortality in our population, resulting in 86 years. Still, also in this scenario, the KM survival analysis did not show significant differences (P=0.120).

Conclusions
In our large real-world contemporary low-to-intermediate risk TAVI population, an age cut-off of 75 years was not associated with any difference in clinical outcomes and survival at 2-years follow-up. This data reinforces the concept that age alone is not a sufficient variable to be considered when choosing between TAVI or SAVR. The recent ESC 2021 VHD guidelines cut-off is justified only by the lack of evidence and valve durability strategy but not of a proper advantage age-related.