Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?
Bibliographic record
Abstract
BackgroundClinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥90 years.MethodsWe conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR among nonagenarians was compared to the provincial estimated survival for an age- and sex- matched general population. Quality of life (QoL) was assessed up to 1 year post-intervention by standardized questionnaires.ResultsDuring the study period, n=268 patients aged ≥90 years were evaluated for severe aortic stenosis. TAVR was performed in n=171 (48% females; median[IQR] Rockwood frailty scale: 4[3-4]), n=84 underwent medical therapy (MT), and n=13 underwent surgical AVR. Survival was significantly better following TAVR compared to MT (adjusted HR[95%CI]: 1.99[1.37-2.88], p<0.001). TAVR demonstrated a survival benefit over that of the general population with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1-year compared to baseline (all p<0.05): the 6-minute walk test improved from 192 to 252m, the Kansas City Cardiomyopathy Questionnaire score from 64 to 81, the Duke Activity Status Index score from 13 to 16, and the health state scale of the Euro QoL-5D from 63 to 74%.ConclusionsNonagenarians undergoing TAVR experience a slightly better survival compared to that of an age-matched general population and have significant improvements in functional status and several QoL indices following the procedure.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".