Long-term survival after transcatheter aortic valve implantation in nonagenarian patients: a multicenter real-world study

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.