Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study
10 affiliations
- 1Cardiology Unit, Specialistic Medicine Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
- 2National Institute for Cardiovascular Research (INRC), Bologna, Italy.
- 3Division of Cardiology, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
- 4Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- 5Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
- 6Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- 7Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
- 8Cardiac Surgery Division, Hesperia Hospital, Modena, Italy.
- 9Cardiology Department, Nuovo Ospedale S. Agostino Estense, Modena, Italy.
- 10Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Abstract
Background: The growing number of nonagenarian patients with severe aortic stenosis has increased interest in transcatheter aortic valve implantation (TAVI) in this population. However, data on long-term outcomes remain limited. This study aimed to evaluate long-term survival and procedural outcomes of TAVI in nonagenarians and to explore clinical factors associated with long-term mortality.
Methods: We conducted an ambispective multicenter observational cohort study including patients aged ≥90 years who underwent TAVI for severe aortic stenosis between 2013 and 2021 at six centers in the Emilia-Romagna region, Italy. Baseline and procedural data were collected retrospectively, while outcome ascertainment combined prospective follow-up contacts with retrospective verification of dates of death or last confirmed vital status. Survival was estimated using the Kaplan–Meier method, and associations with mortality were examined using an exploratory Cox regression analysis.
Results: A total of 60 nonagenarian patients (mean age 91 ± 1.5 years; 67% female) were included. Procedural success was achieved in 97% of cases. In-hospital mortality was 5%, and 30-day mortality was 8.3%. Over a mean observation period of 5.7 years from TAVI to death or the last confirmed vital-status assessment, the Kaplan–Meier estimated 5-year survival was 35%. In the exploratory multivariable analysis, male sex and chronic obstructive pulmonary disease (COPD) were associated with higher long-term mortality.
Conclusions: In patients aged ≥90 years selected by the Heart Team for TAVI, the Kaplan–Meier estimated 5-year survival was 35%. The procedure demonstrated a high success rate and an acceptable safety profile. Male sex and COPD showed an exploratory association with worse prognosis. These findings suggest that TAVI may be a feasible option in carefully selected nonagenarians when guided by comprehensive clinical assessment and individualized decision-making.
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BibTeX
@article{pagnoni2026longterm,
title = {{Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study}},
author = {Gianluca Pagnoni and Marco Loffi and Dalia Caleffi and Susan Darroudi and Giuseppe Masaracchia and Benedetta Frassoni and Francesco Marangi and Sophia di Michele and Davide Gabbieri and Luciano Losi and Alberto Monello and Fabio Alfredo Sgura and Salvatore Arrotti and Rosario Rossi and Daniele Iaccarino and Marco Ruozzi and Vincenzo Guiducci and Filippo Luca Gurgoglione and Giorgio Benatti and Luigi Vignali and Giampaolo Niccoli and Giuseppe Boriani and Daniela Aschieri and Francesca Coppi},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1945453},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1945453/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study
AU - Gianluca Pagnoni
AU - Marco Loffi
AU - Dalia Caleffi
AU - Susan Darroudi
AU - Giuseppe Masaracchia
AU - Benedetta Frassoni
AU - Francesco Marangi
AU - Sophia di Michele
AU - Davide Gabbieri
AU - Luciano Losi
AU - Alberto Monello
AU - Fabio Alfredo Sgura
AU - Salvatore Arrotti
AU - Rosario Rossi
AU - Daniele Iaccarino
AU - Marco Ruozzi
AU - Vincenzo Guiducci
AU - Filippo Luca Gurgoglione
AU - Giorgio Benatti
AU - Luigi Vignali
AU - Giampaolo Niccoli
AU - Giuseppe Boriani
AU - Daniela Aschieri
AU - Francesca Coppi
PY - 2026
DA - 2026/10/08
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1945453
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1945453/full
AB - Background: The growing number of nonagenarian patients with severe aortic stenosis has increased interest in transcatheter aortic valve implantation (TAVI) in this population. However, data on long-term outcomes remain limited. This study aimed to evaluate long-term survival and procedural outcomes of TAVI in nonagenarians and to explore clinical factors associated with long-term mortality. Methods: We conducted an ambispective multicenter observational cohort study including patients aged ≥90 years who underwent TAVI for severe aortic stenosis between 2013 and 2021 at six centers in the Emilia-Romagna region, Italy. Baseline and procedural data were collected retrospectively, while outcome ascertainment combined prospective follow-up contacts with retrospective verification of dates of death or last confirmed vital status. Survival was estimated using the Kaplan–Meier method, and associations with mortality were examined using an exploratory Cox regression analysis. Results: A total of 60 nonagenarian patients (mean age 91 ± 1.5 years; 67% female) were included. Procedural success was achieved in 97% of cases. In-hospital mortality was 5%, and 30-day mortality was 8.3%. Over a mean observation period of 5.7 years from TAVI to death or the last confirmed vital-status assessment, the Kaplan–Meier estimated 5-year survival was 35%. In the exploratory multivariable analysis, male sex and chronic obstructive pulmonary disease (COPD) were associated with higher long-term mortality. Conclusions: In patients aged ≥90 years selected by the Heart Team for TAVI, the Kaplan–Meier estimated 5-year survival was 35%. The procedure demonstrated a high success rate and an acceptable safety profile. Male sex and COPD showed an exploratory association with worse prognosis. These findings suggest that TAVI may be a feasible option in carefully selected nonagenarians when guided by comprehensive clinical assessment and individualized decision-making.
SN - 2297-055X
ER -