Quality of Life and Function After TAVI in Adults Aged ≥90 Years: Frailty and Multimorbidity Matter

INTRODUCTION: Previous reports of transcatheter aortic valve implantation (TAVI) in adults ≥90 years emphasise procedural success and survival. Whether nonagenarians experience clinically meaningful, sustained improvements in patient-reported outcomes, and how frailty and multimorbidity may modify these benefits, remains uncertain. METHODS: We performed an exploratory single-centre retrospective cohort study of consecutive nonagenarians undergoing TAVI (January 2019 - 31 October 2024). EuroQol 5-Dimensions 3-Level (EQ-5D-3L) (including Visual Analogue Scale, VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) Summary Score were collected at baseline, 30 days and 12 months. Responders were defined using a ≥10-point minimally important difference. Deterioration was any negative pre- to 12-month change. Frailty was stratified into three prespecified Clinical Frailty Scale (CFS) categories: 1-3 (fit to managing well), 4-5 (vulnerable to mildly frail), and 6-9 (moderately to severely frail/terminally ill). RESULTS: Of 26 nonagenarians, 19 met inclusion criteria. Most were mildly-moderately frail (CFS 3-5: n=18; CFS 6: n=1). Median 30-day changes were +25 (IQR 10-38) for EQ-5D VAS (exact sign test p=0.001) and +39 (30-50) for KCCQ-12 (p<0.001), with gains largely sustained at 12-months (EQ-5D VAS p=0.096; KCCQ-12 p<0.001). At 12-months, 13/18 (72%) were EQ-5D VAS responders and 17/18 (94%) KCCQ-12 responders. Responder proportions were highest in less frail strata, noting CFS 6-9 contained a single patient. EQ-5D-3L problem burden improved across all domains, especially Mobility (p=0.002) and Usual activities (p=0.012). Twelve-month survival was 94% (18/19). DISCUSSION: In this single-centre nonagenarian cohort, we observed 30-day improvements in symptoms and function following TAVI that were maintained to 12 months. Observed changes appeared smaller with greater frailty and multimorbidity, and higher comorbidity burden coincided with a higher probability of deterioration. Findings should be interpreted as exploratory and hypothesis-generating.