TLE procedure in octogenarians
An increasing age is reflected by higher rates of comorbidities and this makes device management most challenging. 1, 4, 5 In a community-based study, approximately 70% of device recipients were 65 years of age or older and more than 75% had one or more coexisting medical condition.  4, 5 In fact, all patients in our cohort had more than 2 medical comorbidities.  These comorbidities have shown to be associated with the rise in the incidence of extraction procedure complications. In addition, octogenarian population displayed low BMI level that were more likely to experience major adverse events related to the TLE procedure. 19
Nonetheless, there have been several reports that compared the safety and efficacy of TLE between octogenarians and the younger population. Rodriguez et al. compared the clinical outcome of TLE procedures between 118 patients in the octogenarian group and 388 in the younger group and showed that there was no significant difference with respect to the proportion of minor (p =0.65), major (p =0.56), and total (p =0.50) complications. 20 In a multicenter retrospective study consisted of 150 octogenarians and 698 non octogenarians who underwent TLE, periprocedural mortality and major adverse events were similar between the two groups despite the higher prevalence of medical comorbidities in the octogenarians.21 Another multicenter study showed that the outcomes of TLE in 1060 patients with younger population (21-70 years) and 192 octogenarians and again major adverse events were similar in the two cohorts (1.6% vs 1.51%).22 These findings suggested that octogenarians who have an indication for TLE should not be denied the procedure based on age alone.