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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).

Comment

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.

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

Citation(s):

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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