Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement

Abstract

Background: We sought to quantify and compare changes in quality of life measures after transcatheter aortic valve replacement (TAVR) in patients with low-flow (LF) and normal-flow (NF) aortic stenosis (AS).

Transcatheter aortic valve replacement in heart failure

“…However, since patients with classical LFLG AS tended to have worse KCCQ-OS scores at baseline than those with normal flow AS and paradoxical LFLG AS (51 vs. 58 vs. 55, respectively, p = 0.10), they also had lower KCCQ-OS scores at follow-up (67 vs. 74 vs. 69, p = 0.04). 27 In patients with LVEF <50%, significant improvements in 30-day KCCQ-OS scores were noted in patients with low AV gradients (pre-TAVR KCCQ-OS 42 vs. post-TAVR KCCQ-OS 78, p < 0.001) and high AV gradients (pre-TAVR KCCQ-OS 46 vs. post-TAVR KCCQ-OS 80, p < 0.001). 13…”

“…Similar improvements in 30‐day KCCQ have been reported in patients with normal flow AS, classic LFLG AS, and paradoxical LFLG AS in all‐comers undergoing TAVR (Δ KCCQ overall summary [KCCQ‐OS] score 15 vs. 18 vs. 14, respectively p = 0.57). However, since patients with classical LFLG AS tended to have worse KCCQ‐OS scores at baseline than those with normal flow AS and paradoxical LFLG AS (51 vs. 58 vs. 55, respectively, p = 0.10), they also had lower KCCQ‐OS scores at follow‐up (67 vs. 74 vs. 69, p = 0.04) 27 . In patients with LVEF <50%, significant improvements in 30‐day KCCQ‐OS scores were noted in patients with low AV gradients (pre‐TAVR KCCQ‐OS 42 vs. post‐TAVR KCCQ‐OS 78, p < 0.001) and high AV gradients (pre‐TAVR KCCQ‐OS 46 vs. post‐TAVR KCCQ‐OS 80, p < 0.001) 13 …”

“…2 No randomized data exist regarding outcomes post-TAVR in patients with paradoxical LFLG AS since patients with low-gradient AS were often excluded from randomized trials. Paradoxical LFLG AS is present in nearly 25-48% of patients undergoing TAVR 27,28 and in 25-27% of patients with HF and preserved ejection fraction prior to TAVR. 4,29 Studies comparing outcomes in patients with high gradient AS to those with paradoxical LFLG AS undergoing TAVR have yielded conflicting results.…”

Transcatheter Aortic Valve Replacement Improves Quality of Life and Ventricular Function With Low-Flow/Low-Gradient Aortic Stenosis

“… 12 Patients with low-flow/low-gradient stenosis (D2 and D3) also experience a 30-day QoL improvement after TAVR. 13 , 14 However, evidence on QoL outcomes beyond 30 days post-TAVR, particularly for patients with the D2 AS subtype classification, remains scarce. The lack of available QoL and survival benefits for patients with low-flow/low-gradient AS has created uncertainty as to whether these patients should be offered valve intervention.…”

Remove the obstacle and get into the flow!

“…In this issue of Catheterization and Cardiovascular Interventions , Ahmed et al 2 retrospectively compared 30‐day changes in QoL in 297 post‐TAVR patients with NF (43%), CLF (9%), and PLF (48%) AS using the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ‐12) with overall (KCCQ‐OS) and domain‐specific (physical limitation, symptoms, QoL, and social limitation) scores. Baseline KCCQ‐OS was similar in the three groups.…”