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.