1. INTRODUCTION
According to the 2008 World Health Organization report, Japan is the country with the longest life expectancy. 1 The latest report from the Japanese Ministry of Health, Labor and Welfare stated that the life expectancy has reached 81.2 years in men and 87.3 years in women, with 438,000 people over 90 years of age. 2 Unfortunately, this extreme-aged group has an increased prevalence of aortic stenosis and is more likely to have co-morbid conditions, which poses a dilemma to cardiologists and cardiac surgeons when having to choose between conservative or interventional treatment.
Seven years ago, surgical aortic valve replacement (SAVR) was the only treatment for the clinical management of severe aortic stenosis in Japan. However, since 2013, transcatheter aortic valve implantation (TAVI) has been covered by Japanese national health insurance, making it a less invasive alternative to SAVR. 3,4 TAVI was subsequently rapidly adopted, as previously seen in Europeans countries. 5
The widespread use of TAVI and the aging of the population in Japan have led to an increase in the number of TAVI procedures in elderly patients. Some Western studies have reported the outcomes of TAVI for nonagenarians. 6-8 However, there are few reports on TAVI for nonagenarians from Asian countries. The aim of this study was to clarify the outcomes of TAVI in nonagenarians with severe aortic stenosis in Japan.
2. MATERIALS AND METHODS
This study was approved by the Institutional Review Board of Yamaguchi University Hospital (Study ID: H2019-071) with an opt-out consent process, and was conducted in accordance with the Declaration of Helsinki.
A total of 140 patients who were treated at our institution for severe aortic stenosis from April 2014 to July 2019 were included in the study. All patients were assessed by a multidisciplinary cardiac team that included cardiac surgeons, cardiologists, cardiac anesthesiologist, and physical therapists to determine the appropriate treatment strategy. We retrospectively assessed the early and mid-term clinical outcomes after TAVI in nonagenarians (group N; n=23) in comparison to those of younger patients (group Y; n=117).
2.1 Operative procedure
TAVI was performed under general anesthesia with endotracheal
intubation. A temporary right ventricle pacing lead wire was inserted
though the right jugular vein and used when needed. The approach to
deployment of the transcatheter prosthetic valve was discussed by the
cardiac team. The trans-femoral approach was considered as the initial
choice. If a femoral approach was not feasible, a different approach was
utilized. The type and size of the prosthetic valves used were
determined according to the findings in the aortic valve complex on
preoperative enhanced cardiac computed tomography. The Edwards Sapien XT
and Sapien 3 (Edwards Lifesciences, Irvine, CA) were used as
balloon-expandable valves. The Core Valve, Evolut R, and Evolut PRO
(Medtronic Inc., Minneapolis, MN) were used as self-expandable valves.