Contemporary management of aortic stenosis in the elderly. Insights from a recent French registry

Background Indications for transcatheter aortic valve implantation (TAVI) are being extended towards patients who are not at high risk for surgery. Elderly patients are frequently considered at high risk for surgery; however, little is known about their contemporary management. This prospective multicentre registry was designed to assess the therapeutic decision in elderly patients with severe symptomatic aortic stenosis (AS), according to age and surgical risk. Methods From 1st September to 31st October 2016, consecutive patients aged ≥ 75 years and referred for severe symptomatic AS were included in 32 French centres with on-site TAVI and surgery facilities. The primary endpoint was Heart Team therapeutic decision between medical management, TAVI and surgery. Results In total, 1101 patients were included, of whom 1049 had a therapeutic decision (pending decision in 52) and form the population of the study. Mean age was 84 ± 5 years, 560 patients (53%) were female; 235 patients were aged   8%) in 188 patients (18%), intermediate (ESII 4–8%) in 340 (32%), and low (ESII  P P  = 0.008) and an interaction between age and ES II ( P  = 0.02). The significant interaction means that the influence of surgical risk on the therapeutic decision depends on age. Indeed, in the 521 low-risk patients, surgery was the choice in the majority of patients aged between 75 and 80, while TAVI was the most frequent intervention after 80 ( Fig. 1 ). Conclusions This contemporary survey shows that either TAVI or surgery is considered in 90% of patients aged ≥ 75 years with severe symptomatic AS. At the end of 2016, Heart Teams already extended indications for TAVI towards elderly patients at intermediate risk. The impact of risk scores on the choice between TAVI and surgery strongly depends on age. Even in low-risk patients, TAVI is now the most frequent intervention after the age of 80.