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Open Access 01-12-2012 | Research article

Morbidity and mortality of nonagenarians undergoing CoreValve implantation

Authors: Ibrahim Akin, Stephan Kische, Lylia Paranskaya, Henrik Schneider, Tim C Rehders, Gökmen R Turan, Dimitar Divchev, Gunther Kundt, Ilkay Bozdag-Turan, Jasmin Ortak, Ralf Birkemeyer, Christoph A Nienaber, Hüseyin Ince

Published in: BMC Cardiovascular Disorders | Issue 1/2012

Abstract

Background

Nonagenarians are mostly denied from different therapeutic strategies due to high comorbidity index and risk-benefit calculation. We present the results of nonagenarians with high comorbidity index not eligible for conventional aortic valve surgery undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve system.

Methods

Our retrospective analysis include baseline parameters, procedural characteristics, morbidity, mortality as well as twelve-lead surface ECG and echocardiographic parameters which were revealed preinterventionally, at hospital discharge and at 30-day follow-up. Clinical follow-up was performed 6 months after TAVI.

Results

Out of 158 patients 11 nonagenarians with a mean age of 92.6 ± 1.3 years suffering from severe aortic valve stenosis and elevated comorbidity index (logistic EuroSCORE of 32.0 ± 9.5%, STS score 25.3 ± 9.7%) underwent TAVI between January 2008 and January 2011 using the third-generation percutaneous self-expanding CoreValve prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.6 ± 0.2 cm² with a mean and peak pressure gradient of 60.2 ± 13.1mmHg and 91.0 ± 27.4mmHg, respectively. The 30-day follow up all cause and cardiovascular mortality was 27.3% and 9.1%, respectively. One major stroke (9.1%), 2 pulmonary embolisms (18.2%), 1 periprocedural (9.1%) and 1 (9.1%) spontaneous myocardial infarction occured. Life-threatening or disabling bleeding occurred in 2 cases (18.2%), and minor bleeding in 7 cases (63.6%). Mean severity of heart failure according to NYHA functional class improved from 3.2 ± 0.8 to 1.36 ± 0.5 while mean AVA increased from 0.6 ± 0.2cm² to 1.8 ± 0.2cm². At 6-months follow-up 8 patients (72.7%) were alive without any additional myocardial infarction, pulmonary embolism, bleeding, or stroke as compared to 30-day follow-up.

Conclusion

Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with CoreValve.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/12/80/prepub

Title: Morbidity and mortality of nonagenarians undergoing CoreValve implantation
Authors: Ibrahim Akin
Stephan Kische
Lylia Paranskaya
Henrik Schneider
Tim C Rehders
Gökmen R Turan
Dimitar Divchev
Gunther Kundt
Ilkay Bozdag-Turan
Jasmin Ortak
Ralf Birkemeyer
Christoph A Nienaber
Hüseyin Ince
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2012
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-12-80

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Morbidity and mortality of nonagenarians undergoing CoreValve implantation

Abstract

Background

Methods

Results

Conclusion

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