5 Comparison of treatment outcomes in very elderly patients (>85years) with severe symptomatic aortic stenosis

Abstract

Introduction Due to the demographics of our patient population our institution has a high incidence of very elderly (>85 years) patients with severe symptomatic aortic stenosis. We examined the outcomes of these patients following trans-catheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or medical therapy. Methods We included all patients >85 years of age with symptomatic severe aortic stenosis referred to our tertiary centre for consideration of aortic valve intervention between 2009 and 2016. Following assessment by the TAVI team (2 cardiologists and 2 cardiac surgeons) patients underwent SAVR or TAVI. Patients deemed unsuitable or refusing intervention had medical therapy. Data was obtained from electronic databases and clinical case notes. Results 309 patients were included (86 TAVI, 133 SAVR and 90 medical). Comparing patients undergoing TAVI and SAVR, TAVI patients were older (mean age 89.4 years vs. 86.9, p All TAVI patients had surgical access (86% trans-femoral, 8% trans-apical, 6% direct aortic), an Edwards (XT or Sapien 3) valve and general anaesthetic in 69% of cases. There were no intraoperative deaths but 3 conversions to sternotomy for bleeding. 68% of the surgical patients underwent isolated AVR and 32% AVR+CABG with 1 surgical intraoperative death. Medically managed patients had poor outcomes with a mortality of 49% at 1 year and 77% at 3 years. Survival of patients with either intervention was better, with no significant difference in 30-day mortality of SAVR and TAVI (5.3% vs 2.3%, p=049) or 3-year mortality (33% vs. 36%, p=0.66) respectively (figure 1). Compared with TAVI, SAVR patients spent significantly more days on ITU/HDU (8.31±12 vs. 0.96 ±1.7, p Conclusion The prognosis of patients >85 years of age with symptomatic severe aortic stenosis without intervention is poor. Aortic valve intervention in very elderly patients has acceptable mortality out to 3 years. In our early experience, using surgical access and high rates of general anaesthesia, TAVI in this group had similar mortality to SAVR but with significant reductions in both ITU and overall hospital stay. Conflict of Interest none