Long-term survival and outcomes according to age for patients underwent to transcatheter aortic valve replacement
Authors: Munoz-Garcia M , Munoz-Garcia E , Munoz Garcia A J , Dominguez-Franco A J , Jimenez-Navarro M F , Alonso-Briales J H , Hernandez-Garcia J M , Gomez-Doblas J J 
Published: October 2022

Abstract

Background
Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The 2021 ESC/EACTS guidelines for the management of valvular heart disease recommended TAVR in older patients ≥75 years or in those who are high risk. The aim of this study was to determine the survival and the factors predicting mortality after TAVR in according to age.

Methods
From April 2008 to December 2020, a total of 991 patients with symptomatic severe aortic stenosis underwent TAVR with balloon-expandable or self-expanding valves were included. Primary outcomes and survival analysed on base to age &lt;75 years and ≥75 years old.

Results
The mean age in patients &lt;75 compared with ≥75 years, was 68.2±7.5 vs. 81.4±3.8 years and STS score were 4.24±3.1% vs. 5.4±3.1%. In-hospital mortality was 3.8% vs. 3.1%, (OR= 0.825, 95% confidence interval [CI] 0.034–2.037, p=0.676, and the combined endpoint of death, vascular complications, myocardial infarction, major bleeding or stroke was 13.4% vs. 17.8%, OR = 1.39 95% CI 0.842–2.309) p=0.195, respectively.
When compared both groups (75 compared with ≥75 years) in the follow-up, there were no differences in tbleeding 5.7% vs. 3.8% (HR = 0.584 [IC95% 0.278–21.226], p=0.155), myocardial infarction 5% vs. 2.1% (HR = 0.447 [IC95% 0.209–1,090], p=0.08), stroke 5.7% vs. 9.9% (HR = 1.617 [IC95% 0.812–3.219], p=0.171) and mortality 47.2% vs. 44.8% (HR=0.862 [IC95% 0.672–1.105], p=0.241) and there was difference in between groups by hospitalizations for heart failure 16.4% vs. 10.3% (HR = 0.583 [IC95% 0.373–0.912], p=0.018
Survival at 1, 3, 5, and 8 years were similar in both groups (75 compared with ≥75 years): 74.8% vs. 83.4%, 61.1 vs. 69.6%, 45 vs. 51.1% and 35% vs. 31.8% log Rank 1.551, p=0.213, respectively, after a mean follow-up of 44.8±31 months.
The predictors of cumulative mortality were in patients &lt;75 years: Charlson index (HR 1.283 [95% CI 1.037–1.587], p=0.022) and STS score (HR 1.224 [95% CI 1.095–1.368], p=0.001) and the predictors in patients with ≥75 years in addition to Charlson index and STS score, were: Stroke postTAVR (HR 2.692 [95% CI 1.380–5.228], p=0.003), Frailty (HR 1.634 [95% CI 1.159–2.034], p=0.005), reduced left ventricular ejection fraction (HR 0.407 [95% CI 0.191–01.867], p=0,020], COPD (HR 1.472 [95% CI 1.043–2.077], p=0,003], mitral regurgitation post-TAVR (HR 1.190 [1.006–1.409], p=0.043.

Conclusions
TAVR is associated with significant survival benefit throughout 3.29 years of follow-up in both groups. Survival during follow-up was similar in patients with &lt;75 compared with ≥75 years old, but they present some differences in the predictors of mortality, with a greater impact of complications post-TAVR in the elderly.

Funding Acknowledgement
Type of funding sources: None.