Temporal Trends in Quality of Life Outcomes After Transapical Transcatheter Aortic Valve Replacement

Abstract

Background In the PARTNER randomized controlled trial (RCT), which represented the first exposure to transapical transcatheter aortic valve replacement (TA-TAVR) for many clinical sites, high risk patients undergoing TA-TAVR derived similar health-related quality-of-life (HRQoL) outcomes when compared with surgical AVR (SAVR). With increasing experience, it is possible that HRQoL outcomes of TA-TAVR may have improved. Methods and Results We evaluated HRQoL outcomes at 1-, 6-, and 12-month follow-up among 875 patients undergoing TA-TAVR in the PARTNER non-randomized continued access (NRCA) registry, and compared these outcomes with those of the TA-TAVR and SAVR patients in the PARTNER RCT. HRQoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Medical Outcomes Study Short Form-12, and the EuroQoL-5D, with the KCCQ overall summary score serving as the primary endpoint. The NRCA TA-TAVR and RCT TA-TAVR and SAVR groups were generally similar. The primary outcome, the KCCQ summary score, did not differ between the NRCA TA-TAVR and the RCT TA-TAVR group at any follow-up timepoints, although there were small differences in favor of the NRCA cohort on several KCCQ subscales at 1 month. There were no significant differences in follow-up HRQOL between the NRCA-TAVR and the RCT SAVR cohorts on the KCCQ overall summary scale or any of the disease-specific or generic subscales. Conclusions Despite greater experience with TA-TAVR in the NRCA registry, HRQoL outcomes remained similar to those of TA-TAVR in the original RCT cohort and no better than those with SAVR. These findings have important implications for patient selection for TAVR when transfemoral access is not an option. Clinical Trial Registration Placement of AoRTic TraNscathetER Valve [PARTNER] trial; NCT00530894; http://clinicaltrials.gov/show/NCT00530894

Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States

“…However, TA-TAVR is associated with higher mortality and prolonged recovery when compared with TF-TAVR, and unlike TF-TAVR, health-related quality of life after TA-TAVR is no better than SAVR. 19,20 Our study showed that TA-TAVR is also associated with an increased risk of 30-day readmission. This association may be influenced by residual confounding as patients undergoing TA-TAVR are typically sicker with more complex PVD that cannot be captured completely in an administrative database such as the NRD.…”

Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians—surgery still the gold standard?

“…Notably, both changes were higher relative to SAVR. Moreover, a few studies assessed other validated measures of functional status such as the Kansas City Cardiomyopathy Questionnaire (KCCQ), and similar clinically important and favorable changes were observed in high-risk and in-operable patients aged 80 years and over (15)(16)(17)(18).…”

Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach

“…Transapical access for TAVR is an accepted approach for patients in whom vascular anatomy do not permit a transfemoral approach and if on one hand it avoids potential site complications of iliac and femoral vessels, on the other hand has some limitations including an increase in respiratory complications[11]. …”