The number of very old patients with cardiac disease is increasing due to the longer life expectancy. There are few data on incidence and outcome of percutaneous cardiac procedures in patients ≥ 90-years-old (nonagenarians).
To retrospectively analyse the spectrum and outcome of percutaneous cardiac procedures in nonagenarians at our center.
The database at our center from 2005-2014 was searched for all percutaneous cardiac procedures, including coronary angiography with or without percutaneous coronary intervention (PCI), transcatheter aortic valve replacement (TAVR), percutaneous mitral valve repair by MitraClip (PMVR), balloon valvuloplasty of the aortic valve (ABVP) and radiofrequency ablation (RFA). Age at procedure, clinical data, type and findings at procedure, in-hospital outcome, survival and predictors for survival were analyzed.
Among 25,860 percutaneous cardiac procedures, 130 (0.5%) were performed in 93 nonagenarians including 48 women (mean age 91.7 ± 1.8 years at first procedure). Procedures included 85 coronary angiographies (45 including PCI), 25 TAVR, 11 ABVP, 6 PMVR (including one combined with TAVR), and 3 RFA. Overall survival after first procedure (n = 93) was 95% after 1 month, 78% after 1 year and 64% after 2 years. Left ventricular ejection fraction (LVEF) < 40%, history of heart failure, dyspnea NYHA III or IV, mitral valve insufficiency and history of atrial fibrillation were statistically significantly associated with worse estimated survival (p < 0.05, log-rank). These factors showed a strong collinearity in a multivariate survival analysis.
Percutaneous cardiac procedures in nonagenarians represent 0.5% of our procedures and have an acceptable survival rate considering the overall life expectancy in this age group. Further studies are required to delineate optimal patient selection in this age group for an acceptable ratio of procedural risk and benefit regarding survival and quality of life.