Quality of Life After SAPIEN-3 TAVR

Jun 01, 2018
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Authors:
Baron SJ, Thourani VH, Kodai S, et al.
Citation:
Effect of SAPIEN 3 Transcatheter Valve Implantation on Health Status in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: Results From the PARTNER S3i Trial. JACC Cardiovasc Interv 2018;May 30:[Epub ahead of print].
Summary By:
Bina Ahmed, MD, FACC

Study Questions:

Does use of newer-generation SAPIEN-3 (S3) for transcatheter aortic valve replacement (TAVR) result in improved quality of life (QoL) compared with previous-generation transcatheter devices (SAPIEN-XT) and surgical AVR (SAVR) among patients with intermediate surgical risk?

Methods:

A total of 1,078 intermediate surgical risk patients who underwent S3 TAVR were evaluated using Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study Short Form-36, and EQ-5D at baseline, 1 month, and 1 year. QoL outcomes were compared to patients who underwent SAVR or XT-TAVR previously enrolled in the PARTNER 2A trial. Propensity matching was performed to adjust for group differences.

Results:

S3-TAVR was associated with substantial improvements in QoL after 1 year when compared with baseline. At 1 month, S3-TAVR was associated with better QoL than either SAVR or XT-TAVR (adjusted differences in KCCQ-Overall Summary score, 15.6 and 3.7 points, respectively; p < 0.001). At 1 year, the differences in QoL between S3-TAVR and both SAVR and XT-TAVR were reduced, but remained statistically significant (adjusted differences, 2.0 and 2.2 points, respectively; p < 0.05).

Conclusions:

Among intermediate-risk patients, S3-TAVR was associated with greater gains in QoL compared to prior-generation transcatheter valves and SAVR.

Perspective:

Although this is a retrospective analysis, the findings show QoL gains with newer-generation transcatheter valves compared to previous transcatheter technology and SAVR. Short-term improvement in QoL has been demonstrated with TAVR compared to SAVR, and is most likely secondary to absence of sternotomy and the less invasive approach of TAVR. The two surprising findings of the current analysis are: 1) QoL improvement with S3 compared to XT. This may be explained by the lower profile of S3 and more frequent femoral access (vs. nonfemoral TAVR) resulting in the early advantage of S3 over XT. 2) Continued QoL improvement of S3 over XT and SAVR after 1 year. This may be due to lower rates of procedural complications and persistent impact over the long term.

Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Heart Valve Diseases, Heart Valve Prosthesis, Quality of Life, Risk, Secondary Prevention, Sternotomy, Transcatheter Aortic Valve Replacement, Treatment Outcome


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