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DOI: 10.1016/j.rec.2019.10.027
Available online 6 March 2020
Survival in elderly patients with transcatheter aortic valve implants compared with the general population
Supervivencia de los pacientes ancianos con implante percutáneo de válvula aórtica comparados con la población general
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Isaac Pascuala,b,c, Daniel Hernández-Vaquerob,d,
Corresponding author
dhvaquero@gmail.com

Corresponding author: Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Avda. de Roma s/n, 33011 Oviedo, Asturias, Spain.
, Alberto Alperia, Pablo Avanzasa,b,c, Rocío Díazb,d, César Morisa,b,c, Jacobo Silvac,d
a Departamento de Cardiología, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
b Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
c Facultad de Medicina, Universidad de Oviedo, Asturias, Spain
d Departamento de Cirugía Cardiaca, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Tables (5)
Table 1. Characteristics of TAVI patients
Table 2. Operative and postoperative characteristics and complications
Table 3. Most frequent causes of death
Table 4. Predicted survival and cumulative relative survival during each year of follow-up of the TAVI sample and the reference population
Table 5. Predicted survival and cumulative relative survival during each year of follow-up of patients surviving the postoperative period
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Additional material (1)
Abstract
Introduction and objectives

Severe symptomatic aortic stenosis carries a very poor prognosis. Transcatheter aortic valve replacement has been demonstrated to change the natural history of the disease. However, it is not known whether the probability of survival in older patients receiving this treatment returns to a similar value to that in the general population. Our objective was to determine survival in these patients vs that in the general population.

Methods

We retrospectively analyzed the survival curves of patients older than 75 years who underwent transcatheter aortic valve implantation (TAVI) at our hospital and compared them with those in the general population of the same age, sex, and geographic region by using data from the Spanish National Institute of Statistics.

Results

We analyzed 526 patients. Among postoperative survivors, survival curves were similar between the 2 groups during most of the follow-up. In TAVI patients, the probability of survival at 1, 3, 5, and 8 years of follow-up was 90.58% (confidence interval [CI] 95%, 87.54-92.91), 72.51% (95%CI, 67.38-76.97), 53.23% (95%CI, 46.52-59.48), and 35.73% (95%CI, 27.72-43.80). In the reference population, these percentages were 91.93%, 75.63%, 59.6%, and 37.47%.

Conclusions

Long-term survival in elderly patients undergoing TAVI is influenced by postoperative mortality. In patients surviving the postoperative period, the probability of survival returns to a similar value to that in the general population of the same age, sex, and geographical area.

Keywords:
Severe aortic stenosis
Transcatheter aortic valve implantation
Life expectancy
Abbreviations:
INE
RS
TAVI
Resumen
Introducción y objetivos

La estenosis aórtica grave sintomática conlleva un pronóstico ominoso. El recambio percutáneo de válvula aórtica ha mostrado que cambia la historia natural de la enfermedad. Sin embargo, se desconoce si los pacientes mayores intervenidos recuperan una supervivencia similar a la de la población general. Nuestro objetivo es conocerlo.

Métodos

Se analizó de manera retrospectiva la curva de supervivencia de los pacientes mayores de 75 años intervenidos mediante implante percutáneo de válvula aórtica (TAVI) en nuestro centro y se comparó con la población general de iguales edad, sexo y región geográfica utilizando datos del Instituto Nacional de Estadística.

Resultados

Se analizó a 526 pacientes. Una vez superado el periodo posoperatorio, las curvas de supervivencia se igualaron durante la mayor parte del seguimiento. Las probabilidades de sobrevivir para los pacientes TAVI a los 1, 3, 5 y 8 años fueron del 90,58% (intervalo de confianza [IC] del 95%, 87,54-92,91), el 72,51% (IC95%, 67,38-76,97), el 53,23% (IC95%, 46,52-59,48) y el 35,73% (IC95%, 27,72-43,80). En la población de referencia fueron el 91,93, el 75,63, el 59,6 y el 37,47%.

Conclusiones

La supervivencia de los pacientes mayores intervenidos mediante TAVI está condicionada por la mortalidad posoperatoria. Los supervivientes al periodo posoperatorio recuperan una supervivencia similar a la de la población general de iguales edad, sexo y territorio.

Palabras clave:
Estenosis aórtica grave
Implante percutáneo de válvula aórtica
Esperanza de vida

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