{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T04:04:07Z","timestamp":1758945847785,"version":"3.37.3"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Numerous studies have documented the safety of alternatives access (AA) transcatheter aortic valve replacement (TAVR) for patients who are not candidates for transfemoral or surgical approach. There is a scarcity of studies relating use of AA TAVR in nonagenarian patients, a high-risk, frail group. Our study sought to investigate the clinical outcomes of nonagenarians who underwent AA TAVR for aortic stenosis, with comparison of nonagenarians age \u226590 years with patients age &lt;90 years.<\/jats:p><jats:p>Methods\u2003A cohort study of 171 consecutive patients undergoing AA TAVR (transapical [TA, n\u2009=\u2009101, 59%], transaxillary [TAX, n\u2009=\u200956, 33%], transaortic [TAO, n\u2009=\u200911, 6%], and transcarotid [TC, n\u2009=\u20093, 2%]) from 2012 to 2019 was analyzed. Baseline, operative, and postoperative characteristics, as well as actuarial survival outcomes, were compared.<\/jats:p><jats:p>Results\u2003AA TAVR patients had decreased aortic valve gradients with no difference detected in nonagenarians and younger patients. Operative mortality was 8% (n\u2009=\u200914; nine TA, three TAO, and two TAX). Compared to younger patients, significantly more nonagenarians were recorded to have new onset atrial fibrillation (7 vs. 5%, p\u2009&lt;\u20090.01*). No significant difference in mortality or postoperative complications, such as stroke, pacemaker requirements, was detected. Actuarial survival at 1 and 5 years was 86 versus 87% (nonagenarians vs younger patients) and 36 versus 22%, respectively, with log-rank\u2009=\u20090.97.<\/jats:p><jats:p>Conclusion\u2003AA TAVR in nonagenarian patients who are not candidates for transfemoral approach can be efficaciously performed with comparable clinical outcomes to younger patients, age &lt;90 years. Furthermore, some access sites should be avoided when possible; notably TA was associated with increased mortality, stroke, and new onset atrial fibrillation.<\/jats:p>","DOI":"10.1055\/s-0040-1708478","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T23:17:04Z","timestamp":1586215024000},"page":"437-444","source":"Crossref","is-referenced-by-count":3,"title":["Alternative Access Transcatheter Aortic Valve Replacement in Nonagenarians versus Younger Patients"],"prefix":"10.1055","volume":"69","author":[{"given":"Nicole","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Graduate Education, University of Miami Miller School of Medicine, Miami, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcos A.","family":"Nores","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9813-6966","authenticated-orcid":false,"given":"Taylor M.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Graduate Education, University of Miami Miller School of Medicine, Miami, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Rothenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sotiris C.","family":"Stamou","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,4,6]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/j.athoracsur.2015.04.037","article-title":"Outcomes for transcatheter aortic valve replacement in nonagenarians","volume":"100","author":"M O Kayatta","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"23","key":"ref2","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1056\/NEJMoa1103510","article-title":"Transcatheter versus surgical aortic-valve replacement in high-risk patients","volume":"364","author":"C R Smith","year":"2011","journal-title":"N Engl J Med"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s00380-016-0857-3","article-title":"Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature","volume":"32","author":"F Biancari","year":"2017","journal-title":"Heart Vessels"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.athoracsur.2015.02.045","article-title":"Outcomes of Treatment of Nonagenarians With Severe Aortic Stenosis","volume":"100","author":"M C Mack","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/j.athoracsur.2017.02.056","article-title":"Transcatheter aortic valve replacement outcomes in nonagenarians stratified by transfemoral and transapical approach","volume":"103","author":"C McNeely","year":"2017","journal-title":"Ann Thorac Surg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.athoracsur.2015.05.021","article-title":"Outcomes in nonagenarians undergoing transcatheter aortic valve replacement in the PARTNER-I Trial","volume":"100","author":"V H Thourani","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jtcvs.2008.06.028","article-title":"The transapical approach for aortic valve implantation","volume":"136","author":"A Zierer","year":"2008","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"E583","DOI":"10.1002\/ccd.24596","article-title":"Carotid artery access for transcatheter aortic valve replacement","volume":"82","author":"R A Guyton","year":"2013","journal-title":"Catheter Cardiovasc Interv"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.jacc.2009.12.014","article-title":"Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience","volume":"55","author":"J Rod\u00e9s-Cabau","year":"2010","journal-title":"J Am Coll Cardiol"},{"issue":"09","key":"ref10","first-page":"1543","article-title":"Preferential short cut or alternative route: the transaxillary access for transcatheter aortic valve implantation","volume":"7","author":"N Schofer","year":"2015","journal-title":"J Thorac Dis"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3389\/fcvm.2018.00088","article-title":"Access Sites for TAVI: Patient Selection Criteria, Technical Aspects, and Outcomes","volume":"5","author":"L Biasco","year":"2018","journal-title":"Front Cardiovasc Med"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.athoracsur.2014.10.012","article-title":"High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques","volume":"99","author":"V H Thourani","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"19","key":"ref13","doi-asserted-by":"crossref","first-page":"2069","DOI":"10.1001\/jama.2013.282043","article-title":"Outcomes following transcatheter aortic valve replacement in the United States","volume":"310","author":"M J Mack","year":"2013","journal-title":"JAMA"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.athoracsur.2008.04.049","article-title":"United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex","volume":"86","author":"L G Svensson","year":"2008","journal-title":"Ann Thorac Surg"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/ccd.23276","article-title":"Transaortic transcatheter aortic valve implantation using Edwards Sapien valve: a novel approach","volume":"79","author":"V Bapat","year":"2012","journal-title":"Catheter Cardiovasc 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