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Quality of life improves after transcatheter aortic valve implantation

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Health-related quality of life (HRQOL) improves in the year after transcatheter aortic valve implantation (TAVI), researchers from UK and Germany find in 2 separate studies.

“These findings are clinically significant, as improvement in both quality and quantity of life is important to patients and physicians,” Dr. John P. Greenwood from University of Leeds, Leeds, UK told Reuters Health in an email.

TAVI is used to relieve severe aortic stenosis in patients unsuitable for surgical aortic valve replacement, a population in which quality of life may be more important than the absolute survival benefit.

Dr. Greenwood and colleagues assessed serial changes in HRQOL and health utility at 30 days, 6 months, and 1 year after TAVI in 99 patients and sought to identify clinical variables that predict patient benefit. Their findings appear in the May 8th Journal of the American College of Cardiology.

Patients experienced significant improvement over the first year for all physical component scores of the SF-12, but not for the mental component scores. The summary score for physical health increased significantly at all time points, whereas overall mental health did not change significantly from baseline to any of the individual time points.

Health utility improved significantly from baseline to 30 days, improved further at 6 months, and remained significantly higher than baseline at 1 year after TAVI.

Male gender, prior coronary artery bypass graft, and increased experience of the operator were associated with greater improvements in HRQOL at 1 year.

“We were surprised that operator experience had an impact on patients’ HRQOL and not just on the procedural complication rates,” Dr. Greenwood said.

Based on these findings, Dr. Greenwood concluded, measures that could improve patient HRQOL after TAVI include “appropriate patient selection and having the procedure performed in a high volume centre by experienced operators.”

In the second study, published in the April 19th online American Journal of Cardiology, Dr. Markus Krane and colleagues from German Heart Center, Munich, Germany investigated quality of life 1 year after TAVI in 186 patients with severe, symptomatic aortic valve stenosis who were refused for surgical aortic valve replacement.

The mean NYHA class improved significantly from 3.1 at baseline to 1.9 at 3 months and 2.0 at 1 year.

Among the 106 patients who completed the 1-year follow-up protocol, there were significant improvements from baseline in the SF-36 scores for physical functioning, role physical, bodily pain, general health, vitality, and mental health. Scores tended to decrease slightly from 3 months to 1 year of follow-up.

There were no improvements in social functioning or role emotional. As a result, the physical component score improved significantly, whereas there was no significant change in the mental component score.

Greater than mild mitral valve regurgitation and female gender were associated with lower improvements in quality of life.

More than 86% of patients reaffirmed at 3 and 12 months after the procedure their decision to undergo TAVI. Most patients (85% at 3 months, 73% at 12 months) were able to live independently or with only minor help at home.

“Our study adds additional evidence regarding the QOL aspect of TAVI and is in line with previously published studies indicating an improvement in physical QOL in patients followed up for 5, 6, and 12 months,” the researchers conclude.

“The 1-year period might have been too short to assess the effect of QOL by TAVI in these patients,” they add. “The extrapolations from our own data would suggest that after 2 years, there might be a significant increase in NYHA class and worsening of physical and mental QOL scores. Therefore, the longer term dynamics of the observed QOL changes remain elusive.”

SOURCE:
Serial Change in Health-Related Quality of Life Over 1 Year After Transcatheter Aortic Valve Implantation

One-Year Results of Health-Related Quality of Life Among Patients Undergoing Transcatheter Aortic Valve Implantation

J Am Coll Cardiol 2012;59:1672-1680.

Am J Cardiol 19 April 2012.