Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013, 157(1):75-80 | DOI: 10.5507/bp.2012.062

Quality of life after transcatheter aortic valve implantation and surgical replacement in high-risk elderly patients

Petr Kalaa, Martin Tretinab, Martin Poloczeka, Jiri Ondrasekb, Petr Malikb, Petr Pokornyb, Jiri Parenicaa, Jindrich Spinara, Jiri Jarkovskyc, Simona Littnerovac, Petr Nemecb,d
a Department of Internal Cardiology Medicine LF MU and FN Brno, Czech Republic
b Center of Cardiovascular Surgery and Transplantations, Brno
c Institute of Biostatistics and Analyses MU, Brno
d International Clinical Research Center, Brno

Aim: The aim of this study was to compare the quality of life after transcatheter aortic valve implantation (TAVI) and surgical replacement (SAVR) at one year.

Methods: The study included 45 consecutive high-risk patients (average age 82.0 years; logistic Euroscore 22.3%) with symptomatic severe aortic stenosis allocated to TAVI transfemoral, TAVI transapical using the Edwards-Sapien valve or SAVR with the Edwards Perimount bioprosthesis (n=15 in each). The pre-operative characteristics were similar except for more myocardial infarctions in TAVI. The quality of life was assessed using the standardized EQ-5D questionnaire at baseline and on days 30, 90 and 360. The protocol was approved by the local ethics committee and an informed consent was signed. A total of 7 patients (15.5%) died during follow-up.

Results: At baseline no significant differences in any of the quality-of-life parameters were found except for usual activities described as "best" (46.7% in SAVR vs. 10.0% in TAVI; P=0.002). At 30 and 90 days surviving patients were similar and at 360 days only the anxiety/depression score was "best" in 83.3% SAVR vs. 59.1% (P=0.046). Functional status improved in all patients (NYHA class I-II in 13.3% at baseline vs. 78.9% at 360-days) and the general health median significantly improved in TAVI patients (from 50 to 67; P=0.001) with a positive trend in SAVR patients (P=0.060).

Conclusions: At one year, the general quality of life of high-risk patients had significantly improved after transcatheter aortic valve implantation with a positive trend in surgically treated patients.

Keywords: quality of life, EQ-5D, aortic replacement, aortic valve implantation, TAVI, bioprosthesis

Received: February 27, 2012; Accepted: June 11, 2012; Prepublished online: September 5, 2012; Published: March 1, 2013  Show citation

ACS AIP APA ASA Harvard Chicago IEEE ISO690 MLA NLM Turabian Vancouver
Kala, P., Tretina, M., Poloczek, M., Ondrasek, J., Malik, P., Pokorny, P., ... Nemec, P. (2013). Quality of life after transcatheter aortic valve implantation and surgical replacement in high-risk elderly patients. Biomedical papers157(1), 75-80. doi: 10.5507/bp.2012.062
Download citation

References

  1. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24(13):1231-43. Go to original source... Go to PubMed...
  2. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16(1):9-13. Go to original source... Go to PubMed...
  3. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363(17):1597-607. Go to original source... Go to PubMed...
  4. Johansson M, Nozohoor S, Kimblad PO, Harnek J, Olivecrona GK, Sjogren J. Transapical versus transfemoral aortic valve implantation: a comparison of survival and safety. Ann Thorac Surg 2011;91(1):57-63. Go to original source... Go to PubMed...
  5. Rumsfeld JS. Valve Surgery in the Elderly: A Question of Quality (of Life)? J Am Coll Cardiol 2003;42(7):1215-17. Go to original source... Go to PubMed...
  6. Vahanian A, Alfieri OR, Al-Attar N, Antunes M, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr F, Nataf P, Pierard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, Von Segesser LK, Walther T; European Association of Cardio-Thoracic Surgery; European Society of Cardiology; European Association of Percutaneous Cardiovascular Interventions. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2008;34:1-8. Go to original source... Go to PubMed...
  7. Nemec P, Ondrasek J, Malik P, Tretina M, Pokorny P, Poloczek M, Parenica J, Spinar J, Kala P. Comparison of the surgical and transcatheter aortic valve replacement in high-risk patients. Cor et Vasa 2012 (in press) Go to original source...
  8. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001;33(5):337-43. Go to original source... Go to PubMed...
  9. Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C, Morel MA, Petersen J, Popma JJ, Takkenberg JJ, Vahanian A, van Es GA, Vranckx P, Webb JG, Windecker S, Serruys PW. Standardized endpoint definitions for Transcatheter Aortic Valve Implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol 2011;57(3):253-69. Go to original source... Go to PubMed...
  10. Georgiadou P, Kontodima P, Sbarouni E, Karavolias GK, Smirli A, Xanthos T, Troupis T, Khouri M, Papadimitriou L, Voudris V. Long-term Quality of Life Improvement After Transcatheter Aortic Valve Implantation. American Heart Journal 2011;162(2):232-7. Go to original source... Go to PubMed...
  11. Bekeredjian R, Krumsdorf U, Chorianopoulos E, Kallenbach K, Karck M, Katus HA, Rottbauer W. Usefulness of percutaneous aortic valve implantation to improve quality of life in patients >80 years of age. Am J Cardiol 2010;106(12):1777-81. Go to original source... Go to PubMed...
  12. Reynolds MR, Magnuson EA, Lei Y, Leon MB, Smith CR, Svensson LG, Webb JG, Babaliaros VC, Bowers BS, Fearon WF, Herrmann HC, Kapadia S, Kodali SK, Makkar RR, Pichard AD, Cohen DJ for the Placement of Aortic Transcatheter Valves (PARTNER). Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis. Circulation 2011;124:1964-72. Go to original source... Go to PubMed...
  13. Sedrakyan A, Vaccarino V, Paltiel AD, Elefteriades JA, Mattera JA, Sarah A. Roumanis SA, Zhenqiu Lin Z, Krumholz HM. Age does not limit quality of life improvement in cardiac valve surgery. J Am Coll Cardiol 2003;42:1208-14. Go to original source... Go to PubMed...
  14. Sedrakyan A, Hebert P, Vaccarino V, Paltiel AD, Elefteriades JA, Mattera J, Lin Z, Roumanis SA, Krumholz HM. Quality of life after aortic valve replacement with tissue and mechanical implants. J Thorac Cardiovasc Surg 2004;128:266-72. Go to original source... Go to PubMed...