Original ArticleComparison of Health Related Quality of Life in Transcatheter Versus Surgical Aortic Valve Replacement: A Meta-Analysis
Introduction
Transcatheter aortic valve replacement (TAVR) has been shown to offer similar mortality benefits compared to surgical aortic valve replacement (SAVR) in both randomised control trials and real-world cohorts for intermediate and high-surgical risk patients with symptomatic, severe aortic stenosis [1], [2], [3], [4]. Although TAVR and SAVR both result in significant mortality reduction, morbidity and mortality rates remain high after TAVR due to advanced age, significant comorbidities, and clinical events such as stroke, myocardial infarction and heart failure. The 5-year follow-up from the Placement of Aortic Transcatheter Valves (PARTNER) trial showed 67.8% mortality and even the most recent Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial showed 11.4% of mortality at 2-year follow-up [1], [4].
In these patients with high mortality risk after aortic valve replacement, health-related quality of life (HRQOL) is an important outcome to assess the effectiveness of the procedure. Past studies have mainly focussed on the improvement in HRQOL pre and post TAVR or SAVR, with significant improvements of post-procedural HRQOL [5], [6], [7]. However, little is known about the comparative effects of TAVR (transfemoral [TF] or non-TF, i.e. transcarotid, transsubclavian, transapical or transaortic) vs. SAVR on HRQOL. Transcatheter aortic valve replacement could potentially offer a higher degree of HRQOL improvement because of its minimally invasive nature.
Therefore, we performed a systematic review of HRQOL differences between TAVR and SAVR.
Section snippets
Materials and Methods
This systematic review and meta-analysis was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A literature search was conducted through PubMed and EMBASE from inception to 25 October 2017. Two independent reviewers (TA and HT) performed the search separately. The search terms were the following: aortic valve AND (percutaneous OR transcatheter OR transluminal OR transarterial OR transapical OR transaortic OR transcarotid OR transaxillary
Results
A total of four studies [16], [17], [18], [19] were identified and included in our quantitative meta-analysis. Details of study selection flows are summarised in the supplemental material. Reynold et al. reported outcomes from PARTNER [16], Arnold et al. from CoreValve U.S. pivotal trial [17], and Baron et al. from PARTNER 2 trial [19]. Gada et al. compared HRQOL scores between transapical-TAVR from non-randomised continued access registry of the PARTNER trial and SAVR cohort of the randomised
Discussion
In this systematic review and meta-analysis, we found that 1: HRQOL scores were higher for TF-TAVR compared to SAVR for both heart failure specific and generic health assessment tools, but were similar for non-TF TAVR vs. SAVR at 30-days and 2: TF and non-TF TAVR both conferred similar HRQOL scores in both heart failure specific and generic health assessment tools at 1-year follow-up.
There are several potential explanations for the higher HRQOL score in TF-TAVR compared to SAVR at 30 days.
Acknowledgements
None.
Disclosures
None.
References (24)
- et al.
5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial
Lancet
(2015) - et al.
Transcatheter versus surgical aortic valve replacement: propensity-matched comparison
J Am Coll Cardiol
(2017) - et al.
3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement
J Am Coll Cardiol
(2016) - et al.
Quality of life after transcatheter aortic valve replacement: prospective data from GARY (German Aortic Valve Registry)
JACC Cardiovasc Interv
(2016) - et al.
Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document
J Am Coll Cardiol
(2012) - et al.
Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure
J Am Coll Cardiol
(2000) - et al.
Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease
J Clin Epidemiol
(2000) - et al.
Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A)
J Am Coll Cardiol
(2012) - et al.
Health status after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis at increased surgical risk: results from the CoreValve US pivotal trial
JACC Cardiovasc Interv
(2015) - et al.
2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
J Am Coll Cardiol
(2017)
Surgical or transcatheter aortic-valve replacement in intermediate-risk patients
N Engl J Med
Quality-of-life outcomes after transcatheter aortic valve replacement in an unselected population: a report from the STS/ACC transcatheter valve therapy registry
JAMA Cardiol
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