Elsevier

Heart, Lung and Circulation

Volume 28, Issue 8, August 2019, Pages 1235-1245
Heart, Lung and Circulation

Original Article
Comparison of Health Related Quality of Life in Transcatheter Versus Surgical Aortic Valve Replacement: A Meta-Analysis

https://doi.org/10.1016/j.hlc.2018.07.013Get rights and content

Background

Data on the effects of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) on health-related quality of life (HRQOL) outcomes are limited. To assess the comparative HRQOL outcomes between TAVR and SAVR, we performed a systematic review and meta-analysis.

Methods

PubMed and EMBASE databases were searched for articles that compared the HRQOL scores, Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study Short-Form Health Survey 12 or 36 (SF-12/36), or the EuroQoL 5 Dimension score (EQ-5D) at 30 days and 1 year between TAVR and SAVR. Mean difference (MD) and 95% confidence interval (CI) was calculated with inverse variance statistical method and random-effects model.

Results

A total of four studies with 4,125 patients (1268 transfemoral [TF]-TAVR, 1261 Non-TF TAVR [transsubclavian, transapical or transaortic], and 1,596 SAVR) were included in the studies. KCCQ overall summary scores and its subscales, SF-12/36, and EQ-5D were significantly higher in TF-TAVR compared to SAVR but were similar in non-TF TAVR vs. SAVR at 30 days. At 1-year follow-up, TF-TAVR and non-TF TAVR conferred similar HRQOL scores in KCCQ overall summary and subscales scores, SF-12/36, and EQ-5D compared to SAVR.

Conclusions

Transfermoral-TAVR achieved better HRQOL at 30 days but similar HRQOL at 1 year compared to SAVR. Non-TF TAVR resulted in similar improvements in HRQOL at both 30 days and 1 year compared with SAVR.

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.

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