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.