Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients.

Kleiman, Neal S; Van Mieghem, Nicolas M; Reardon, Michael J; Gada, Hemal; Mumtaz, Mubashir; Olsen, Peter Skov; Heiser, John; Merhi, William; Chetcuti, Stanley; Deeb, G Michael; Chawla, Atul; Kiaii, Bob; Teefy, Patrick; Chu, Michael W A; Yakubov, Steven J; Windecker, Stephan; Althouse, Andrew D; Baron, Suzanne J (2024). Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC. Cardiovascular Interventions, 17(8), pp. 979-988. Elsevier 10.1016/j.jcin.2024.02.014

Text 1-s2.0-S193687982400459X-main.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (930kB)

BACKGROUND

Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown.

OBJECTIVES

The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial.

METHODS

Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling.

RESULTS

Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups.

CONCLUSIONS

In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).

Interest & Impact

Downloads

0 since deposited on 01 May 2024
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item