Citation: Annals of Thoracic Surgery. 100(3):785-92; discussion 793, 2015 Sep..Journal: The Annals of thoracic surgery.ISSN: 1552-6259.Full author list: Thourani VH; Jensen HA; Babaliaros V; Kodali SK; Rajeswaran J; Ehrlinger J; Blackstone EH; Suri RM; Don CW; Aldea G; Williams MR; Makkar R; Svensson LG; McCabe JM; Dean LS; Kapadia S; Cohen DJ; Pichard AD; Szeto WY; Herrmann HC; Devireddy C; Leshnower BG; Ailawadi G; Maniar HS; Hahn RT; Leon MB; Mack M.UI/PMID: 26242213.Subject(s): Age Factors | Aged, 80 and over | Female | Humans | Male | Time Factors | Transcatheter Aortic Valve Replacement/mt [Methods] | *Transcatheter Aortic Valve Replacement | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Randomized Controlled TrialOnline resources: Click here to access onlineDigital Object Identifier: http://dx.doi.org/10.1016/j.athoracsur.2015.05.021 (Click here)Abbreviated citation: Ann Thorac Surg. 100(3):785-92; discussion 793, 2015 Sep.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: This study describes short-term and mid-term outcomes of nonagenarian patients undergoing transfemoral or transapical transcatheter aortic valve replacement (TAVR) in the Placement of Aortic Transcatheter Valve (PARTNER)-I trial.Abstract: METHODS: From April 2007 to February 2012, 531 nonagenarians, mean age 93 +/- 2.1 years, underwent TAVR with a balloon-expandable prosthesis in the PARTNER-I trial: 329 through transfemoral (TF-TAVR) and 202 transapical (TA-TAVR) access. Clinical events were adjudicated and echocardiographic results analyzed in a core laboratory. Quality of life (QoL) data were obtained up to 1 year post-TAVR. Time-varying all-cause mortality was referenced to that of an age-sex-race-matched US population.Abstract: RESULTS: For TF-TAVR, post-procedure 30-day stroke risk was 3.6%; major adverse events occurred in 35% of patients; 30-day paravalvular leak was greater than moderate in 1.4%; median post-procedure length of stay (LOS) was 5 days. Thirty-day mortality was 4.0% and 3-year mortality 48% (44% for the matched population). By 6 months, most QoL measures had stabilized at a level considerably better than baseline, with Kansas City Cardiomyopathy Questionnaire (KCCQ) 72 +/- 21. For TA-TAVR, post-procedure 30-day stroke risk was 2.0%; major adverse events 32%; 30-day paravalvular leak was greater than moderate in 0.61%; and median post-procedure LOS was 8 days. Thirty-day mortality was 12% and 3-year mortality 54% (42% for the matched population); KCCQ was 73 +/- 23.Abstract: CONCLUSIONS: A TAVR can be performed in nonagenarians with acceptable short- and mid-term outcomes. Although TF- and TA-TAVR outcomes are not directly comparable, TA-TAVR appears to carry a higher risk of early death without a difference in intermediate-term mortality. Age alone should not preclude referral for TAVR in nonagenarians.Copyright � 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.