Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry

Background: The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing. Aims: The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old. Methods: All patients undergoing TAVI (n=8,626) from...

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Authors: Witberg G., Landes U., Codner P., Barbanti M., Valvo R., De Backer O., Ooms J.F., McInerney A., Masiero G., Werner P., Armario X., Fiorina C., Arzamendi D., Santos-Martinez S., Baz J.A., Steblovnik K., Mauri V., Adam M., Merdler I., Hein M., Ruile P., Russo M., Musumeci F., Sedaghat A., Sugiura A., Grasso C., Branca L., Estévez-Loureiro R., Amat-Santos I.J., Mylotte D., Andreas M., Bunc M., Tarantini G., Nombela-Franco L., Sondergaard L., Van Mieghem N.M., Finkelstein A., Kornowski R.
Format: article
Status:Published version
Publication Date:2022
Country:España
Institution:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repository:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p15856
Online Access:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=15856
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743236
Access Level:Open access
Keyword:aged
Article
clinical outcome
cohort analysis
diabetes mellitus
female
groups by age
health center
human
lung disease
major clinical study
male
mortality
patient referral
prevalence
register
scoring system
surgical risk
transcatheter aortic valve implantation
treatment indication
treatment outcome
adverse event
aortic valve
aortic valve stenosis
heart valve replacement
middle aged
procedures
risk factor
Aged
Aortic Valve
Aortic Valve Stenosis
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Registries
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
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spelling Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registryWitberg G.Landes U.Codner P.Barbanti M.Valvo R.De Backer O.Ooms J.F.McInerney A.Masiero G.Werner P.Armario X.Fiorina C.Arzamendi D.Santos-Martinez S.Baz J.A.Steblovnik K.Mauri V.Adam M.Merdler I.Hein M.Ruile P.Russo M.Musumeci F.Sedaghat A.Sugiura A.Grasso C.Branca L.Estévez-Loureiro R.Amat-Santos I.J.Mylotte D.Andreas M.Bunc M.Tarantini G.Nombela-Franco L.Sondergaard L.Van Mieghem N.M.Finkelstein A.Kornowski R.agedArticleclinical outcomecohort analysisdiabetes mellitusfemalegroups by agehealth centerhumanlung diseasemajor clinical studymalemortalitypatient referralprevalenceregisterscoring systemsurgical risktranscatheter aortic valve implantationtreatment indicationtreatment outcomeadverse eventaortic valveaortic valve stenosisheart valve replacementmiddle agedproceduresrisk factorAgedAortic ValveAortic Valve StenosisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedRegistriesRisk FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeBackground: The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing. Aims: The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old. Methods: All patients undergoing TAVI (n=8,626) from the 18 participating centres between January 2007 and June 2020 were stratified by age (</>70). For patients <70, the indications for TAVI were extracted from Heart Team discussions and the baseline characteristics and mortality were compared between the two groups. Results: Overall, 640 (7.4%) patients were <70 (9.1% during 2018-2020, p<0.001); the mean age was 65.0±2.3 years. The younger patients were more often male, with bicuspid valves or needing valve-in-valve procedures. They had a higher prevalence of lung disease and diabetes. In 80.7% of cases, the Heart Team estimated an increased surgical risk and TAVI was selected, reflected by an STS score >4% in 20.4%. Five-year mortality was similar (29.4 vs 29.8%, HR 0.95, p=0.432) in the <70 and >70 groups. In the <70 group, mortality was higher for those referred for TAVI due to an increased surgical risk compared to those referred for other reasons (31.6 vs 24.5%, HR 1.23, p=0.021). Mortality was similar regardless of the STS stratum in patients judged by the Heart Team to be at increased surgical risk (32.6 vs 30.4%, HR 0.98, p=0.715). Conclusions: Use of TAVI in patients <70 is becoming more frequent. The main reason for choosing TAVI is due to an increased surgical risk not adequately represented by the STS score. The outcomes for these patients are similar to those for older TAVI patients. Dedicated trials of TAVI/SAVR in younger patients are needed to guide decisions concerning expansion of TAVI indications. © Europa Digital & Publishing 2022. All rights reserved.EUROPA EDITION2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=15856https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743236EuroInterventionISSN: 1774024XISSNe: 19696213reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p158562026-06-14T12:41:47Z
dc.title.none.fl_str_mv Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
title Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
spellingShingle Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
Witberg G.
aged
Article
clinical outcome
cohort analysis
diabetes mellitus
female
groups by age
health center
human
lung disease
major clinical study
male
mortality
patient referral
prevalence
register
scoring system
surgical risk
transcatheter aortic valve implantation
treatment indication
treatment outcome
adverse event
aortic valve
aortic valve stenosis
heart valve replacement
middle aged
procedures
risk factor
Aged
Aortic Valve
Aortic Valve Stenosis
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Registries
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
title_short Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
title_full Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
title_fullStr Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
title_full_unstemmed Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
title_sort Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
dc.creator.none.fl_str_mv Witberg G.
Landes U.
Codner P.
Barbanti M.
Valvo R.
De Backer O.
Ooms J.F.
McInerney A.
Masiero G.
Werner P.
Armario X.
Fiorina C.
Arzamendi D.
Santos-Martinez S.
Baz J.A.
Steblovnik K.
Mauri V.
Adam M.
Merdler I.
Hein M.
Ruile P.
Russo M.
Musumeci F.
Sedaghat A.
Sugiura A.
Grasso C.
Branca L.
Estévez-Loureiro R.
Amat-Santos I.J.
Mylotte D.
Andreas M.
Bunc M.
Tarantini G.
Nombela-Franco L.
Sondergaard L.
Van Mieghem N.M.
Finkelstein A.
Kornowski R.
author Witberg G.
author_facet Witberg G.
Landes U.
Codner P.
Barbanti M.
Valvo R.
De Backer O.
Ooms J.F.
McInerney A.
Masiero G.
Werner P.
Armario X.
Fiorina C.
Arzamendi D.
Santos-Martinez S.
Baz J.A.
Steblovnik K.
Mauri V.
Adam M.
Merdler I.
Hein M.
Ruile P.
Russo M.
Musumeci F.
Sedaghat A.
Sugiura A.
Grasso C.
Branca L.
Estévez-Loureiro R.
Amat-Santos I.J.
Mylotte D.
Andreas M.
Bunc M.
Tarantini G.
Nombela-Franco L.
Sondergaard L.
Van Mieghem N.M.
Finkelstein A.
Kornowski R.
author_role author
author2 Landes U.
Codner P.
Barbanti M.
Valvo R.
De Backer O.
Ooms J.F.
McInerney A.
Masiero G.
Werner P.
Armario X.
Fiorina C.
Arzamendi D.
Santos-Martinez S.
Baz J.A.
Steblovnik K.
Mauri V.
Adam M.
Merdler I.
Hein M.
Ruile P.
Russo M.
Musumeci F.
Sedaghat A.
Sugiura A.
Grasso C.
Branca L.
Estévez-Loureiro R.
Amat-Santos I.J.
Mylotte D.
Andreas M.
Bunc M.
Tarantini G.
Nombela-Franco L.
Sondergaard L.
Van Mieghem N.M.
Finkelstein A.
Kornowski R.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv aged
Article
clinical outcome
cohort analysis
diabetes mellitus
female
groups by age
health center
human
lung disease
major clinical study
male
mortality
patient referral
prevalence
register
scoring system
surgical risk
transcatheter aortic valve implantation
treatment indication
treatment outcome
adverse event
aortic valve
aortic valve stenosis
heart valve replacement
middle aged
procedures
risk factor
Aged
Aortic Valve
Aortic Valve Stenosis
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Registries
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
topic aged
Article
clinical outcome
cohort analysis
diabetes mellitus
female
groups by age
health center
human
lung disease
major clinical study
male
mortality
patient referral
prevalence
register
scoring system
surgical risk
transcatheter aortic valve implantation
treatment indication
treatment outcome
adverse event
aortic valve
aortic valve stenosis
heart valve replacement
middle aged
procedures
risk factor
Aged
Aortic Valve
Aortic Valve Stenosis
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Registries
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
description Background: The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing. Aims: The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old. Methods: All patients undergoing TAVI (n=8,626) from the 18 participating centres between January 2007 and June 2020 were stratified by age (</>70). For patients <70, the indications for TAVI were extracted from Heart Team discussions and the baseline characteristics and mortality were compared between the two groups. Results: Overall, 640 (7.4%) patients were <70 (9.1% during 2018-2020, p<0.001); the mean age was 65.0±2.3 years. The younger patients were more often male, with bicuspid valves or needing valve-in-valve procedures. They had a higher prevalence of lung disease and diabetes. In 80.7% of cases, the Heart Team estimated an increased surgical risk and TAVI was selected, reflected by an STS score >4% in 20.4%. Five-year mortality was similar (29.4 vs 29.8%, HR 0.95, p=0.432) in the <70 and >70 groups. In the <70 group, mortality was higher for those referred for TAVI due to an increased surgical risk compared to those referred for other reasons (31.6 vs 24.5%, HR 1.23, p=0.021). Mortality was similar regardless of the STS stratum in patients judged by the Heart Team to be at increased surgical risk (32.6 vs 30.4%, HR 0.98, p=0.715). Conclusions: Use of TAVI in patients <70 is becoming more frequent. The main reason for choosing TAVI is due to an increased surgical risk not adequately represented by the STS score. The outcomes for these patients are similar to those for older TAVI patients. Dedicated trials of TAVI/SAVR in younger patients are needed to guide decisions concerning expansion of TAVI indications. © Europa Digital & Publishing 2022. All rights reserved.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=15856
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743236
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=15856
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743236
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv EUROPA EDITION
publisher.none.fl_str_mv EUROPA EDITION
dc.source.none.fl_str_mv EuroIntervention
ISSN: 1774024X
ISSNe: 19696213
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.81155

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