Long-term quality of life improvement after transcatheter aortic valve implantation

Γεωργιάδου, Παναγιώτα; Kontodima, Panagiota; Sbarouni, Eftihia; Karavolias, George; Smirli, Anna; Xanthos, Theodoros; Troupis, Theodore; Khouri, Mazen; Papadimitriou, Lila; Voudris, Vassilis

doi:10.1016/j.ahj.2011.06.004

Cited by 40 publications

(30 citation statements)

References 21 publications

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“…5 In our analysis, however, EOHM were associated with higher 6 month mortality and increased need for repeat hospitalization, and no improvement in 6-minute walk distance or NYHA functional class when compared to ST patients. Thus, better identification of patients who are at the highest risk of EOHM may aid in limiting procedures that have limited efficacy or may not affect survival.…”

Section: Discussioncontrasting

confidence: 64%

“…1-4 Additionally, quality of life improvements are associated with TAVI. 5,6 Despite these encouraging results, all-cause mortality following TAVI in high-risk patients remains high (44% at 3 years) 7 . Much of this mortality is not procedural, but rather a result of existing comorbidities and other contributing patient characteristics, including advanced age, that adversely influence long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Early Out-of Hospital Mortality After Transcatheter Aortic Valve Implantation Among Patients With Aortic Stenosis Successfully Discharged from the Hospital and Alive at 30 Days (from the Placement of Aortic Transcatheter Valves Trial)

Beohar

Zajarías

Thourani

et al. 2014

The American Journal of Cardiology

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In high risk/inoperable patients with severe symptomatic aortic stenosis, transcatheter aortic valve implantation (TAVI) is a proven alternative to standard (i.e., medical) therapy (ST) or surgical AVR. Concerns have been raised, however, about patients who survive the procedure but have a short subsequent survival. We therefore sought to identify correlates of early out-of-hospital mortality (EOHM) among patients undergoing successful TAVI, rendering TAVI potentially “futile”. Patients who were discharged from the hospital and survived >30 days but <12 months after TAVI were identified (EOHM group). Independent predictors of EOHM were explored, including patient-level factors and procedural non-fatal major complications (NFMC). A sensitivity analysis was also performed excluding patients with NFMC. Among 485 patients who were discharged from the hospital and survived 30 days following TAVI, 101 (21%) were dead within one year. Independent predictors of EOHM included serum creatinine, liver disease, coagulopathy, mental status, body mass index, male gender, and STS score. Although NFMC were strongly associated with EOHM, patient-level risk factors for EOHM were similar among patients who did and did not experience NFMC. Compared to ST, TAVI patients with EOHM had similar 6-month 6-minute walk distance & functional class, with higher rates of repeat hospitalization. In conclusion, among high risk/inoperable patients undergoing TAVI who were discharged and alive at 30 days, EOHM was not infrequent, and was largely determined by presenting characteristics and the occurrence of peri-procedural NFMC. Careful screening and minimization of NFMC may maximize the benefit of TAVI.

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Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Analysis of Early Out-of Hospital Mortality After Transcatheter Aortic Valve Implantation Among Patients With Aortic Stenosis Successfully Discharged from the Hospital and Alive at 30 Days (from the Placement of Aortic Transcatheter Valves Trial)

Beohar

Zajarías

Thourani

et al. 2014

The American Journal of Cardiology

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“…On average, the PCS score improved at 6–11 months (range: 6.3, 18.4 points) and 12 months (4.9, 26.9 points) (Figure 2). After excluding influential studies by Bekeredjian(66), Georgiadou(67), and Taramasso(68), the improvement was modest, yet clinically important at 12 months. The improvement in MCS score, however, seemed smaller than the change in PCS score at 6–11 months (2.0, 13.3 points) and 12 months (1.0, 8.9 points) (Figure 3).…”

Section: Resultsmentioning

confidence: 94%

Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement

et al. 2014

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Background Transcatheter aortic valve replacement (TAVR) prolongs survival in high-risk patients with severe aortic stenosis. However, its functional and quality-of-life benefits have not been established. Purpose To evaluate the changes in functional status and quality of life after TAVR. Data Sources MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from January 1, 2002, to September 30, 2013. Study Selection Studies of TAVR that reported the New York Heart Association (NYHA) class, Short-Form (SF)-12/36 physical and mental component summary (points), or other measures of functional status. Data Extraction Two reviewers independently extracted the mean change (follow-up – baseline) in primary outcomes. Due to substantial heterogeneity, data were not pooled; the range (minimum, maximum) of mean change was summarized. Data Synthesis We identified 60 observational studies (56 pre-post comparison and 4 head-to-head comparative studies) and 2 randomized controlled trials (11,205 patients). Most studies showed a clinically important decrease in NYHA class at 6–11 months (range: −0.8, −2.1), 12–23 months (−0.8, −2.1), 24–35 months (−1.2, −2.6), and ≥36 months (−1.2, −1.6). The improvement in SF-12/36 physical component score was clinically important over 12 months (4.9, 26.9), while the change in mental component score was smaller (1.0, 8.9). Clinically important improvements were observed in other disease-specific measures and 6-minute walk test, but less consistently seen in general health measures. Limitations Comparative evidence is limited by few head-to-head studies of functional outcomes. Survivor bias may have overestimated the benefits. Conclusions TAVR provides clinically important benefits in physical function and disease-specific measures of quality of life, but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision-making.

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“…Furthermore, several studies showed a significant improvement of QoL in intermediate and long-term perspective [17,[25][26][27][28]. Reynolds et al [29] analysed 358 high-risk patients as a sub-study of the PARTNER trial.…”

Section: Discussionmentioning

confidence: 99%

Improvement of quality of life following transcatheter aortic valve implantation in the elderly: a multi-centre study based on the Polish national TAVI registry

et al. 2017

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A b s t r a c tBackground: Transcatheter aortic valve implantation (TAVI) is an effective therapeutic method for elderly high-risk patients with symptomatic severe aortic stenosis, not eligible for surgical treatment. Aim:The aim of the study was to evaluate short-term changes in elderly people's quality of life following TAVI, based on the POL-TAVI registry. Methods:One hundred and eighty-four octogenarians' and nonagenarians' samples from the POL-TAVI database were included in the study. The quality of life status was assessed with EQ-5D-3L questionnaire at baseline and after one-month follow-up. Results:The mean of patients' age was 84 (80-93) years. Logistic EuroSCORE mean was 19.83% (3.48-83.94%), and transaortic mean gradient was 54.99 (19.0-149.0) mm Hg. At baseline, up to 24.50% of patients declared severe problems in performing usual activities. 13.60% felt extreme pain or discomfort; 9.80% were unable to wash and dress by themselves; 8.20% were extremely anxious or depressed; and 7.10% of the patients in the study were confined to bed. After 30 days the percentage of patients declaring severe problems in each dimension did not exceed 4.00%. The comparison between quality of life data at baseline and after one-month follow-up showed a significant improvement in each of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression (p < 0.001). Patients' quality of life was increasing regardless of gender (female vs. male), the type of anaesthesia (general vs. local), and the type of procedure (TA vs. TF). Conclusions:Short-term quality of life in the elderly subjects was significantly improved after one-month follow-up following TAVI.

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Long-term quality of life improvement after transcatheter aortic valve implantation

Cited by 40 publications

References 21 publications

Analysis of Early Out-of Hospital Mortality After Transcatheter Aortic Valve Implantation Among Patients With Aortic Stenosis Successfully Discharged from the Hospital and Alive at 30 Days (from the Placement of Aortic Transcatheter Valves Trial)

Analysis of Early Out-of Hospital Mortality After Transcatheter Aortic Valve Implantation Among Patients With Aortic Stenosis Successfully Discharged from the Hospital and Alive at 30 Days (from the Placement of Aortic Transcatheter Valves Trial)

Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement

Improvement of quality of life following transcatheter aortic valve implantation in the elderly: a multi-centre study based on the Polish national TAVI registry

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