Indications for TAVI are being extended towards patients who are not at high surgical risk. Elderly patients are frequently considered at high risk but little is known about their contemporary management. This prospective multicentre registry aimed to assess the therapeutic decision in elderly patients with severe symptomatic aortic stenosis, according to age and surgical risk.

In September–October 2016, consecutive patients aged≥75 years 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.

1049 patients with a therapeutic decision were included. Mean age was 84±5 years, 560 patients (53%) were female. In total, 235 patients were aged <80 years, 364 between 80 and 85 and 450 ≥85. Mean EuroSCORE II (ESII) was 5.9±6.0%. Surgical risk was classified as high (ESII>8%) in 188 patients (18%), intermediate (ESII 4–8%) in 340 (32%), and low (ESII<4%) in 521 (50%). Decision was medical therapy in 102 patients (10%), surgery in 199 (19%) and TAVI in 748 (71%). Mean ES II was 9.1±9.1% in the medical group, 2.9±2.1% in the surgery group and 6.2±5.8% in the TAVI group. TAVI was chosen for 79% of high-risk patients, 80% for intermediate-risk patients and 63% for low-risk patients. Among the 947 patients with a decision of TAVI or surgery, the choice of TAVI was associated with older age (P<0.0001), higher ES II (P=0.008) and an interaction between age and ES II (P=0.02). 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 (Figure 1).

1) Either TAVI or surgery is considered in 90% of patients ≥75 years. 2) At the end of 2016, Heart Teams already extended indications for TAVI towards elderly patients at intermediate risk. 3) The impact of risk scores on the choice between TAVI and surgery strongly depends on age.