Quality of Life After Transapical TAVR | Journal Scan
Does increasing operator experience with transapical (TA) transcatheter aortic valve replacement (TAVR) result in improved measures of patient quality of life?
Health-related quality-of-life outcomes were assessed at 1, 6, and 12 months among 875 patients undergoing TA-TAVR in the PARTNER (AoRTic TraNscathetER Valve) nonrandomized continued access registry, and those outcomes were compared with those of the TA-TAVR and surgical aortic valve replacement (SAVR) patients in the PARTNER randomized controlled trial. Quality of life 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 continued access registry TA-TAVR and randomized controlled trial TA-TAVR and SAVR groups were generally similar. The primary outcome, the KCCQ summary score, did not differ between the continued access registry TA-TAVR and the randomized controlled trial TA-TAVR group at any follow-up time points, although there were small differences in favor of the continued access registry cohort on several KCCQ subscales at 1 month. There were no significant differences in follow-up quality-of-life assessments between the continued access registry TAVR and the randomized controlled trial SAVR cohorts on the KCCQ overall summary scale, or on any of the disease-specific or generic subscales.
Despite greater experience with TA-TAVR in the nonrandomized continued access registry, measures of health-related quality-of-life outcomes remained similar to those of patients who underwent TA-TAVR in the original randomized controlled trial, and were no better than those with SAVR. The authors concluded that these findings have important implications for patient selection for TAVR when transfemoral access is not an option.
In the PARTNER trial, high-risk patients who underwent TA-TAVR experienced similar quality-of-life outcomes compared to patients who underwent SAVR. Another study (Reynolds MR, et al. J Am Coll Cardiol 2012;60:548-58) found that health-related quality of life was better after transfemoral TAVR than after SAVR. The present study provides additional, albeit indirect, evidence that transfemoral access for TAVR is favorable if feasible. With the higher upfront cost of TAVR compared to SAVR, demonstration of superior clinical outcomes with TAVR compared to SAVR should be required to justify its use—not demonstrated in this assessment of quality of life following TA-TAVR.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Aortic Valve, Aortic Valve Stenosis, Cardiac Surgical Procedures, Cardiomyopathies, Follow-Up Studies, Heart Valve Diseases, Heart Valve Prosthesis, Patient Selection, Quality of Life, Questionnaires, Registries, Transcatheter Aortic Valve Replacement
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