To the Editor The indications of transcatheter aortic valve replacement (TAVR) are expanding to include more elderly patients. However, the safety and efficacy of TAVR in the super-elderly has yet to be investigated. Saito et al. compared the clinical outcomes following TAVR in patients <85 years old and ≥85 years old (1). They showed that the outcomes of super-elderly patients following TAVR were acceptable. Several points should be addressed to improve these findings.
The 30-day mortality was worse in patients ≥85 years old than in those <85 years old (1). However, our main concern involves any improvement (or rather worsening) in the quality of life following TAVR in such a super-elderly cohort. The authors showed that the New York Heart Association functional classes following TAVR were not significantly different, regardless of the patients' age. However, this index might be subjective. Instead, a comparison of the Barthel index might clarify the impact of TAVR on patients' frailty (2).
The dominant in-hospital complications in patients ≥85 years old who died within 30 days was “life-threatening or major bleeding” (1). A peri-procedural pharmacological strategy involving the use of anti-platelet and anti-coagulation agents might require re-consideration in such a super-elderly cohort.
In general, the clinical outcomes following TAVR are not satisfactory in patients with low-flow low-gradient aortic stenosis (3). Another concern is the clinical outcomes in patients ≥85 years old with low-flow low-gradient aortic stenosis.
The author states that he has no Conflict of Interest (COI).
Financial Support
TI receives grant support from JSPS KAKENHI: JP20K17143.
References
- 1.Saito Y, Erik EL, Raval A, et al. The prognosis of elderly patients with aortic stenosis after transcatheter aortic valve replacement. Intern Med 60: 517-523, 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]
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