How Will I Do After Transcatheter Aortic Valve Replacement?

Summary and Comment |
February 19, 2014

How Will I Do After Transcatheter Aortic Valve Replacement?

  1. Joel M. Gore, MD

Inconsistent data on functional and quality-of-life changes suggest an overall benefit but highlight a critical need for more research to improve patient selection.

  1. Joel M. Gore, MD

Transcatheter aortic valve replacement (TAVR) has emerged as a safe and efficacious alternative to surgical treatment in high-risk or inoperable patients with symptomatic, severe aortic stenosis (NEJM JW Cardiol Jun 8 2011). To assess functional status and quality of life after TAVR, investigators conducted a systematic review of 60 observational studies and 2 randomized, controlled trials involving 11,205 TAVR patients.

In 56 pre- and post-TAVR comparisons, mean age ranged from 73 to 93, female sex ranged from 14% to 94%, and baseline New York Heart Association (NYHA) class III or IV symptoms ranged from 54% to 100%. Most studies showed a decrease of ≥1 in NYHA class at 6 to 11 months and at 12 to 23 months. Increases in the physical component of the Short Form-12/36 score were clinically meaningful (≥2.5 points) at 12 months; changes in the mental component were generally positive but smaller than changes in the physical component. Clinically meaningful improvements were found in other disease-specific measures (e.g., Kansas City Cardiomyopathy Questionnaire) but were not consistently seen in general-health measures (e.g., EuroQol-5D).


The patient characteristics and degree of improvement in functional outcomes varied considerably among the studies in this review. Overall trends toward improvement were seen in symptoms, physical function, and disease-specific quality-of-life measures with transcatheter aortic valve replacement. However, improvements in psychological and general-health measures were small and inconsistent. TAVR increases survival in symptomatic patients who are not candidates for surgery. Nonetheless, well-designed, prospective studies of quality-of-life and functional outcomes are needed to identify patients who will truly feel better after the procedure.

Editor Disclosures at Time of Publication

  • Disclosures for Joel M. Gore, MD at time of publication Grant / research support NIH; NIH-NHLBI; NSF


Reader Comments (3)

ALEXANDER ROTH Physician, Allergy/Immunology, retired

I have been followed for aortic stenosis for 6 years. I am now 94 yrs old and although ECHO's show increasing stenosis I am essentially asymptomatic. This makes me reluctant to opt for TAVR.

zohar brill Physician, Cardiology, private place

I have a few patients that pass this procedure
the result are mixed. some improved but some have aortic insufficiency bleeding and deterioration of heart failure. i know that this people are old and not healthy but the result are not so good

mario marzilli

TAVR is biased by major methodologic faults in the PARTNER trial

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