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Open Access Research article

Morbidity and mortality of nonagenarians undergoing CoreValve implantation

Ibrahim Akin1*, Stephan Kische1, Lylia Paranskaya1, Henrik Schneider1, Tim C Rehders1, Gökmen R Turan1, Dimitar Divchev1, Gunther Kundt2, Ilkay Bozdag-Turan1, Jasmin Ortak1, Ralf Birkemeyer1, Christoph A Nienaber1 and Hüseyin Ince1

Author Affiliations

1 Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany

2 Institute for Biostatistics and Information in Medicine and Ageing Research, Rostock School of Medicine, University Hospital Rostock, Ernst-Heydemann-Str 6, 18057, Rostock, Germany

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BMC Cardiovascular Disorders 2012, 12:80  doi:10.1186/1471-2261-12-80

Published: 24 September 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.

Keywords:
CoreValve; Aortic stenosis; Nonagenarian; Surgery; TAVI