"Select patients age  years and older with aortic stenosis AS can benefit from a relatively new minimally invasive surgery for aortic valve replacement according to an article in the September  issue of the Annals of Thoracic Surgery.  Key points  Both transfemoral and transapical approaches to TAVR appear to be safe and effective for treatment of aortic stenosis in select patients age  years and older.   By  months postsurgery most qualityoflife measures had stabilized at a level considerably better than baseline meaning patients quality of life was better than it was prior to surgery.   Future studies are needed to address potential differences in outcomes between TF and TATAVR groups. As part of the PARTNERI trial Vinod H. Thourani MD from Emory University in Atlanta and colleagues from  other institutions in the United States found that transcatheter aortic valve replacement TAVR is a safe and effective way to treat aortic stenosis in nonagenarians who qualify for the surgical technique. Historically extreme elderly patients can be at a very high risk for open surgery said Dr. Thourani. We still believe that for those  year olds who are lowor intermediate risk surgical options may be a viable procedure. However with the advent of TAVR technology we can now offer these extreme elderly patients a treatment option that otherwise would have been highrisk or prohibitive. Aortic stenosis is the most common acquired valve disease in elderly patients and affects nearly  of those over the age of  according to the American Heart Association. The ability to safely treat AS patients has become increasingly important the US government predicts that the number of Americans over the age of  will exceed  million in the next  years. For the study the researchers used two different approaches transfemoral TAVR TFTAVR which is the traditional approach performed via the groin and transapical TAVR TATAVR which is performed via the heart muscle. TATAVR is an alternative for patients who are medically ineligible for TFTAVR secondary to severe peripheral vascular disease. While the current study did not evaluate other alternative options for TAVR these techniques may include transaortic transcaval transcarotid or transsubclavian.  In the largest series published to date between April  and February   nonagenarians underwent TAVR  with TFTAVR and  with TATAVR. We evaluated perioperative short and midterm outcomes following both TF and TATAVR explained Dr. Thourani. Compared with an agesexracematched US population the TAVR patients had a comparable risk of mortality and quality of life improved within  months of the procedure. Our study shows that age alone should not preclude referral for TAVR in patients age  years and older.  The study also showed that the day stroke risk was . in TFTAVR patients and . in TATAVR patients. Major complications such as bleeding or vascular issues occurred in  of TFTAVR patients and  of TATAVR patients and more than  of patients were discharged home after the procedure. Future studies are needed to address potential differences in outcomes between TF and TATAVR groups said Dr. Thourani but Im thrilled that were able to give elderly people the chance to continue enjoying life in their golden years. Many would not have had that option without TAVR.  Notes for editors  Thourani V Jensen H Babaliaros V Kodali S Rajeswaran J Ehrlinger J Blackstone E Suri R Don C Aldea G Williams M Makkar R Svensson L McCabe J Dean L Kapadia S Cohen D Pichard A Szeto W Herrmann H Devireddy C Leshnower B Ailawadi G Maniar H Hahn R Leon M Mack M. Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve Replacement in the PARTNERI Trial. Ann Thorac Surg . doi.j.athoracsur... Full text of the article is available to credentialed journalists upon request contact Cassie McNulty cmcnultysts.org mailtocmcnultysts.org at     About The Annals of Thoracic Surgery  The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association. Founded in  The Society of Thoracic Surgeons is a notforprofit organization representing more than  cardiothoracic surgeons researchers and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart lung and esophagus as well as other surgical procedures within the chest. The Societys mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education research and advocacy.  About Elsevier  Elsevier is a worldleading provider of information solutions that enhance the performance of science health and technology professionals empowering them to make better decisions deliver better care and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides webbased digital solutions  among them ScienceDirect Scopus Elsevier Research Intelligence and ClinicalKey  and publishes over  journals including The Lancet and Cell and more than  book titles including a number of iconic reference works. Elsevier is part of RELX Group plc a worldleading provider of information solutions for professional customers across industries. http"