Outcomes of nonagenarians after transcatheter aortic valve implantation

Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline characteristics of nonagenarians treated with TAVI and determine whether age = 90 years is associated with a worse prognosis compared to non-nonagenarian patients. Methods: We included all patients =75 years enrolled in the multicenter prospective Spanish TAVI registry between 2009 and 2018. Patients < 75 years were excluded. Results: A total of 8073 elderly patients (= 75 years) from 46 Spanish centers were enrolled in the Spanish TAVI registry; 7686 were between = 75 and < 90 years old (95.2%), and 387 were nonagenarian patients (4.79%). A gradual increase of nonagenarians was observed. The transfemoral access was used in 91.6% of the cases, predominantly among the nonagenarian patients (91.4% vs 95.1%, P = .01). Nonagenarians were more likely to die during their hospital stay (4.3% vs 7.0% among nonagenarians, P = .01). However, no difference was seen in the all-cause mortality rates reported at the 1-year follow-up (8.8% vs 11.3%, P =.07). In the multivariate analysis, age = 90 years was not independently associated with a higher adjusted all-cause mortality rate (HR, 1.37, 95%CI, 0.91–1.97, P = .14). The baseline creatinine levels, and the in-hospital bleeding complications were all associated with a worse long-term prognosis in nonagenarians treated with TAVI. Conclusions: Nonagenarians are a very high-risk and growing population with severe AS in whom TAVI may be a safe and effective strategy. Careful patient selection by the TAVI heart team is mandatory to achieve maximum efficiency in this population where the baseline kidney function and bleeding complications may determine the long-term prognosis after TAVI. © 2021 Sociedad Española de Cardiología. Published by Permanyer Publications

P1 337. Reparación valvular mitral: experiencia en nuestro centro

ObjetivoEl gold standard en el tratamiento de la insuficiencia mitral es la reparación valvular mitral siempre que ésta sea posible. Nuestro objetivo es exponer la experiencia en nuestro centro.Material y métodosDesde mayo de 2006 hasta la fecha actual hemos realizado 135 reparaciones mitrales. La edad media de los pacientes es de 62,87 años (22–84 años), siendo 68 varones (64,15%). En la distribución por etiologías destaca la degenerativa (68,3%). Realizamos 24,8% plastias mitrales complejas. El seguimiento de los volúmenes ventriculares se ha realizado preoperatoriamente mediante ecocardiografía y cardiorresonancia magnética.ResultadosLa mortalidad hospitalaria fue de 3 casos (2,8%). Los exitus fueron en pacientes con cirugía concomitante, siendo las causas de origen no cardíaco en dos de ellos. La reducción media de los volúmenes ventriculares telediastólicos y telesistólicos fue de 9,7mm (terapia de destino [DT] 14mm) y de 5,59mm (DT 12mm), respectivamente, con una significación estadística de p<0,05. La reducción del volumen ventricular fue significativamente superior cuando el volumen telesistólico del ventrículo izquierdo (VTSVI) es inferior a 45mm. Con un seguimiento medio de 32 meses (1–70 meses) la supervivencia libre de reintervención es del 91±7,5%. La supervivencia global a 1 y 4 años es del 94,4±3% y 90,1±5,1%.ConclusionesGracias a la curva de aprendizaje no solo realizamos reparación valvular sencilla sino que hemos aumentado los casos de reparación valvular compleja, obteniendo excelentes resultados con mínima morbimortalidad. La mayor reducción de volúmenes ventriculares, cuando éstos son menores preoperatoriamente, indican que la cirugía debe ser precoz