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Metra M, Radulescu CI, Cersosimo A, Massussi M, Laurito A, Chioncel O, Adamo M. Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence. J Cardiovasc Med (Hagerstown) 2024; 25:259-270. [PMID: 38488063 DOI: 10.2459/jcm.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Aortic stenosis is the most prevalent valvular heart disease requiring intervention, especially in the elderly population. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are well established treatment options for symptomatic patients with severe aortic stenosis, as they provide a significant survival benefit. Aortic stenosis may have an important impact on patients' quality of life (QoL). However, advanced age, comorbidities and frailty may limit the beneficial effect of aortic stenosis interventions in terms of QoL. Current guidelines mention the importance of frailty and avoiding the futility of interventions, but lack specific indications about decision-making. Also, there are limited data on how to specifically assess QoL in aortic stenosis patients since the most used questionnaires are validated in different populations (i.e. heart failure). The aim of this review is to summarize all the available tools for QoL assessment in patients with aortic stenosis; to report current evidence on the impact of TAVI on QoL; and to discuss the role of frailty and comorbidities in this setting.
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Affiliation(s)
- Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Crina-Ioana Radulescu
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- University of Medicine and Pharmacy Carol Davila
| | - Angelica Cersosimo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Massussi
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Laurito
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- University of Medicine and Pharmacy Carol Davila
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Marianna Adamo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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2
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Frank D, Kennon S, Bonaros N, Romano M, Di Mario C, van Ginkel DJ, Bor W, Kasel M, De Backer O, Hachaturyan V, Lüske CM, Kurucova J, Bramlage P, Styra R. Quality of Life Measures in Aortic Stenosis Research: A Narrative Review. Cardiology 2023; 148:556-570. [PMID: 37442111 PMCID: PMC10733944 DOI: 10.1159/000531465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Elderly patients with aortic stenosis (AS) not only have a reduced life expectancy but also a reduced quality of life (QoL). The benefits of an AS intervention may be considered a balance between a good QoL and a reasonably extended life. However, the different questionnaires being used to determine the QoL were generally not developed for the specific situation of patients with AS and come with strengths and considerable weaknesses. The objective of this article was to provide an overview of the available QoL instruments in AS research, describe their strengths and weaknesses, and provide our assessment of the utility of the available scoring instruments for QoL measurements in AS. SUMMARY We identified and reviewed the following instruments that are used in AS research: Short Form Health Survey (SF-36/SF-12), EuroQol-5D (EQ-5D), the Illness Intrusiveness Rating Scale (IIRS), the HeartQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHF), the MacNew Questionnaire, and the Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ). KEY MESSAGES There is no standardized assessment of QoL in patients with AS. Many different questionnaires are being used, but they are rarely specific for AS. There is a need for AS-specific research into the QoL of patients as life prolongation may compete for an improved QoL in this elderly patient group.
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Affiliation(s)
- Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Critical Care), UKSH University Clinical Center Schleswig-Holstein and DZHK (German Centre for Cardiovascular Research), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wilbert Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Markus Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ole De Backer
- Interventional Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
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Quality of Life Assessment in Patients Undergoing Trans-Catheter Aortic Valve Implantation Using MacNew Questionnaire. Am J Cardiol 2022; 164:103-110. [PMID: 34819234 DOI: 10.1016/j.amjcard.2021.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
The MacNew questionnaire is a disease-specific quality of life measure that has been used in patients with myocardial infarction and heart failure. We aimed to investigate the impact of transcatheter aortic valve implantation (TAVI) on health-related quality of life (HRQoL) using MacNew Questionnaire and identify predictors associated with a change in its score. This was a prospective multi-center study performed across 5 National Health Service hospitals in the United Kingdom performing TAVI between 2016 and 2018. HRQoL was assessed using MacNew Questionnaire, Euro Quality of Life-5D-5L, and Short Form 36 questionnaires collected at baseline, 3-, 6- and 12 months after the procedure. Out of 225 recruited patients, 19 did not have TAVI and 4 withdrew their consent, and hence 202 patients were included. HRQoL was assessed in 181, 161, and 147 patients at 3, 6, and 12 months, respectively. Using MacNew, there was a significant improvement in all domains of HRQoL as early as 3 months after TAVI which was sustained up to 12 months with improved discrimination of change in HRQoL compared with other scales. Poor mobility at baseline and history of myocardial infarction were independent predictors of reduced improvement in HRQoL at 3 months. HRQoL increased in all subgroups of patients including frail ones. In conclusion, the MacNew assessment tool performed well in a representative TAVI cohort and could be used as an alternative disease-specific method for assessing HRQoL change after TAVI.
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4
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Edwards KS, Chow EKH, Dao C, Hossepian D, Johnson AG, Desai M, Shah S, Lee A, Yeung AC, Fischbein M, Fearon WF. Impact of cognitive behavioral therapy on depression symptoms after transcatheter aortic valve replacement: A randomized controlled trial. Int J Cardiol 2020; 321:61-68. [PMID: 32800909 DOI: 10.1016/j.ijcard.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/04/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression is a significant concern after cardiac surgery and has not been studied in patients undergoing transcatheter aortic valve replacement (TAVR). We sought to examine the prevalence of pre-procedure depression and anxiety symptoms and explore whether brief bedside cognitive behavioral therapy (CBT) could prevent post-TAVR psychological distress. METHODS We prospectively recruited consecutive TAVR patients and randomized them to receive brief CBT or treatment as usual (TAU) during their hospitalization. Multi-level regression techniques were used to evaluate changes by treatment arm in depression, anxiety, and quality of life from baseline to 1 month post-TAVR adjusted for sex, race, DM, CHF, MMSE, and STS score. RESULTS One hundred and forty six participants were randomized. The mean age was 82 years, and 43% were female. Self-reported depression and anxiety scores meeting cutoffs for clinical level distress were 24.6% and 23.2% respectively. Both TAU and CBT groups had comparable improvements in depressive symptoms at 1-month (31% reduction for TAU and 35% reduction for CBT, p = .83). Similarly, both TAU and CBT groups had comparable improvements in anxiety symptoms at 1-month (8% reduction for TAU and 11% reduction for CBT, p = .1). Quality of life scores also improved and were not significantly different between the two groups. CONCLUSIONS Pre-procedure depression and anxiety may be common among patients undergoing TAVR. However, TAVR patients show spontaneous improvement in depression and anxiety scores at 1-month follow up, regardless of brief CBT. Further research is needed to determine whether more tailored CBT interventions may improve psychological and medical outcomes.
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Affiliation(s)
| | - Eric K H Chow
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Catherine Dao
- Department of Medicine, Stanford University, United States of America
| | - Derik Hossepian
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Audrey G Johnson
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Sonia Shah
- Department of Medicine, Stanford University, United States of America
| | - Anson Lee
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - Alan C Yeung
- Department of Medicine, Stanford University, United States of America
| | - Michael Fischbein
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - William F Fearon
- Department of Medicine, Stanford University, United States of America
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5
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Takeji Y, Taniguchi T, Morimoto T, Saito N, Ando K, Shirai S, Sakaguchi G, Arai Y, Fuku Y, Kawase Y, Komiya T, Ehara N, Kitai T, Koyama T, Watanabe S, Watanabe H, Shiomi H, Minamino-Muta E, Matsuda S, Yaku H, Yoshikawa Y, Yamazaki K, Kawatou M, Sakamoto K, Tamura T, Miyake M, Sakaguchi H, Murata K, Nakai M, Kanamori N, Izumi C, Mitsuoka H, Kato M, Hirano Y, Inada T, Nagao K, Mabuchi H, Takeuchi Y, Yamane K, Tamura T, Toyofuku M, Ishii M, Inoko M, Ikeda T, Ishii K, Hotta K, Jinnai T, Higashitani N, Kato Y, Inuzuka Y, Morikami Y, Minatoya K, Kimura T. Transcatheter aortic valve implantation versus conservative management for severe aortic stenosis in real clinical practice. PLoS One 2019; 14:e0222979. [PMID: 31557200 PMCID: PMC6762145 DOI: 10.1371/journal.pone.0222979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is criticized by some as an expensive treatment in super-elder patients with limited life expectancy. However, there is a knowledge gap regarding the magnitude of clinical benefit provided by TAVI in comparison with conservative management in patients with severe aortic stenosis (AS) in real clinical practice, which would be important in the decision making for TAVI. Methods We combined two independent registries, namely CURRENT AS and K-TAVI registries. CURRENT AS was a multicenter registry enrolling 3815 consecutive patients with severe AS irrespective to treatment modalities between January 2003 and December 2011. K-TAVI was a multicenter, prospective registry including 449 consecutive patients with severe AS, who underwent TAVI with SAPIEN XT balloon-expandable valves between October 2013 and June 2016. In these 2 registries, 449 patients received TAVI and 894 patients were managed with conservative strategy. We conducted propensity score matching and finally obtained a cohort of 556 patients (278 patients for each group) for the analysis. The primary outcome measures were all-cause death and heart failure (HF) hospitalization at 2-year. Results The cumulative 2-year incidences of all-cause death and HF hospitalization were significantly lower in the TAVI group than in the conservative group (16.8% versus 36.6%, P<0.001, and 10.7% versus 37.2%, P<0.001). After adjusting the residual confounders, TAVI reduced the risks of all-cause death (HR, 0.46; 95%CI, 0.32–0.69; P = 0.0001) and HF hospitalizations (HR, 0.25; 95%CI, 0.16–0.40; P<0.0001) compared with conservative strategy. There was no difference in the cumulative incidence of non-cardiovascular death between the 2 groups. Conclusions TAVI in the early Japanese experience was associated with striking risk reduction for all-cause death as well as HF hospitalization as compared with the historical cohort of patients with severe AS who were managed conservatively just before introduction of TAVI in Japan.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Genichi Sakaguchi
- Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshio Arai
- Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadaaki Koyama
- Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Minamino-Muta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahide Kawatou
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | | | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masanao Nakai
- Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirokazu Mitsuoka
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yutaka Hirano
- Department of Cardiology, Kinki University Hospital, Osakasayama, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yasuyo Takeuchi
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Kozo Hotta
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | | | - Yoshihiro Kato
- Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Yuko Morikami
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Khalil C, Megaly M, Ekladios C, Ibrahim A, Mosleh W, Tawadros M, Yatsynovich Y, Ramanan T, Youssef M, Hanna N, Khalil M, Al-Azizi KM, Shamoun F, Page B, Corbelli J. Evaluation of YouTube as a reliable source for patient education on aortic valve stenosis. Cardiovasc Diagn Ther 2019; 9:371-378. [PMID: 31555542 DOI: 10.21037/cdt.2019.08.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Aortic stenosis (AS) is a prevalent disease in the elderly population and has been a public health concern for decades. YouTube is currently being used for obtaining healthcare related information. We evaluated the quality of information about AS on YouTube for patient education. Methods YouTube was queried for the search phrases "aortic valve stenosis", "aortic valve replacement", "transcatheter aortic valve replacement" and "TAVR". Videos were assessed for their reliability and content with two five-point scales. They were categorized into groups according to usefulness and uploader source. All videos were assessed for audience interaction. Videos were viewed and analyzed by 2 independent investigators. Conflicts were resolved by a third investigator. Results Search phrases yielded 69,300 videos, among which, 120 videos were evaluated and 85 videos were included in the final analysis. Of the 85 videos, only 45 videos (53%) were found to be useful while 40 videos (47%) were found to be non-useful. The majority (98%) of the useful videos were uploaded by professional sources. Overall, videos uploaded by non-professional sources had higher number of views (23,553 vs. 11,110, P≤0.001) despite of being less useful (14% vs. 67%, P<0.001) when compared to videos uploaded by professional sources. Conclusions There is a potential to increase public awareness about aortic valve stenosis and the available treatment options by utilizing YouTube. Professional societies are encouraged to provide more useful material that can deliver comprehensive and reliable information in an entertaining and intuitive manner to the public.
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Affiliation(s)
- Charl Khalil
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Michael Megaly
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA.,Division of Cardiology, Hennepin Healthcare, Minneapolis, MN, USA
| | - Catherine Ekladios
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Amira Ibrahim
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Wassim Mosleh
- Division of Cardiology, University of Connecticut, Farmington, CT, USA
| | - Mariam Tawadros
- Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Yan Yatsynovich
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Tharmathai Ramanan
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mina Youssef
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nader Hanna
- Division of Cardiology, Cleveland Clinic, Weston, FL, USA
| | - Mofid Khalil
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Karim M Al-Azizi
- Division of Interventional Cardiology and Structural Heart Disease, The Heart Hospital Plano, Baylor Scott & White, Plano, TX, USA
| | - Fadi Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Brian Page
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - John Corbelli
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
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Straiton N, Jin K, Bhindi R, Gallagher R. Functional capacity and health-related quality of life outcomes post transcatheter aortic valve replacement: a systematic review and meta-analysis. Age Ageing 2018; 47:478-482. [PMID: 29377982 DOI: 10.1093/ageing/afx203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/23/2017] [Indexed: 12/11/2022] Open
Abstract
Background transcatheter aortic valve replacement (TAVR) provides prognostic benefit for high surgical-risk patients with severe aortic stenosis (AS), yet the impact to patient outcomes is far less understood. Method we performed a systematic review and meta-analysis to evaluate functional capacity and health-related quality of life (HRQoL) outcomes for patients up to 12 months post TAVR. A total of 20 eligible publications, comprising randomised-controlled trials, observational studies and a registry study were identified from electronic databases, including MEDLINE, EMBASE, Cochrane Library and others (inception to February 2017). Results the total sample was 2,775 with a mean age of 81.8 ± 2.1 years, more than half (52%) were female and high surgical risk 9.6 ± 4.3% mean STS (Society of Thoracic Surgeons risk model). Post TAVR, patients had significant improvement in functional capacity of >40 m in the 6-minute walk test (6MWT) (95% confidence interval (CI) 9.69-73.28) and a clinically meaningful increase in ability to perform daily physical-based tasks (Duke Activity Status Index (DASI), mean difference (MD) increase 5.42 points, 95% CI 3.16-7.68). HRQoL improved consistently following TAVR regardless of measure used. Significant increases occurred in the physical component summary scores (PCS) of the short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12) points). Conclusion functional capacity and HRQoL improved substantially following TAVR, despite evolving patient selection criteria, thus TAVR continues to provide a directly beneficial option for severe AS patients.
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Affiliation(s)
- Nicola Straiton
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kai Jin
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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8
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Barbanti M, Baan J, Spence MS, Iacovelli F, Martinelli GL, Saia F, Bortone AS, van der Kley F, Muir DF, Densem CG, Vis M, van Mourik MS, Seilerova L, Lüske CM, Bramlage P, Tamburino C. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation - rationale and design of the FAST-TAVI registry. BMC Cardiovasc Disord 2017; 17:259. [PMID: 29017461 PMCID: PMC5635502 DOI: 10.1186/s12872-017-0693-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing trend towards shorter hospital stays after transcatheter aortic valve implantation (TAVI), in particular for patients undergoing the procedure via transfemoral (TF) access. Preliminary data suggest that there exists a population of patients that can be discharged safely very early after TF-TAVI. However, current evidence is limited to few retrospective studies, encompassing relatively small sample sizes. METHODS The Feasibility And Safety of early discharge after Transfemoral TAVI (FAST-TAVI) registry is a prospective observational registry that will be conducted at 10 sites across Italy, the Netherlands and the UK. Patients will be included if they have been scheduled to undergo TF-TAVI with the balloon-expandable SAPIEN 3 transcatheter heart valve (THV; Edwards Lifesciences, Irvine, CA). The primary endpoint is a composite of all-cause mortality, vascular-access-related complications, permanent pacemaker implantation, stroke, re-hospitalisation due to cardiac reasons, kidney failure and major bleeding, occurring during the first 30 days after hospital discharge. Patients will be stratified according to whether they were high or low risk for early discharge (≤3 days) (following pre-specified criteria), and according to whether or not they were discharged early. Secondary endpoints will include time-to-event (Kaplan-Meier) analysis for the primary outcome and its individual components, analysis of the relative costs of early and late discharge, and changes in short- and long-term quality of life. Multivariate logistic regression will be used to identify factors that indicate that a patient may be suitable for early discharge. DISCUSSION The data gathered in the FAST-TAVI registry should help to clarify the safety of early discharge after TF-TAVI and to identify patient and procedural characteristics that make early discharge from hospital a safe and cost-effective strategy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02404467 (registration first received March 23rd 2015).
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Affiliation(s)
- Marco Barbanti
- Catania Division of Cardiology, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, Catania, Italy.
| | - Jan Baan
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark S Spence
- Cardiology Department, Royal Victoria Hospital, Belfast, UK
| | - Fortunato Iacovelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Francesco Saia
- Cardiovascular and Thoracic Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Douglas F Muir
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Cameron G Densem
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Marije Vis
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Claudia M Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Corrado Tamburino
- Catania Division of Cardiology, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, Catania, Italy
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Boureau AS, Trochu JN, Rouaud A, Hureau R, Jaafar P, Manigold T, Letocart V, Guerin P, Berrut G, de Decker L. Predictors of Health-Related Quality of Life Decline after Transcatheter Aortic Valve Replacement in Older Patients with Severe Aortic Stenosis. J Nutr Health Aging 2017; 21:105-111. [PMID: 27999856 DOI: 10.1007/s12603-016-0739-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transcatheter aortic-valve implantation (TAVI) has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, one-third of patients have poor outcome as death, functional decline or quality of life (QoL) decline. The aim of this study was to determine cardiac and geriatric predictors of physical and mental QoL decline 6 months after a TAVI procedure in patients aged 75 and older. METHODS Between January 2013 and June 2014, we did a prospective and multicenter study including patients ≥ 75 years old referred for TAVI. The primary outcome was the measure of QoL, assessed by the Short Form 36 survey (SF-36), before and 6 months after the intervention. Association between QoL decline and baseline characteristics including cardiac and geriatric factors was analysed by logistic regression models. RESULTS Mean age of the 150 patients studied was 83.7 years old and 56% were men. The primary end point, mean SF-36 physical summary score, significantly improved between baseline and 6-month (33.6 vs. 36.4, p=0.003) whereas mental component score significantly decreased (48.2 vs. 36.4, p-value<0.001). However, patients with presence of depressive symptoms before the intervention had mental QoL improvement at six months (OR 0.04 [0.01-0.19], p-value<0.001) and no significant geriatric predictors were associated with physical QoL decline. CONCLUSION The mental QoL significantly decreased and patients with preoperative depressive symptoms had mental QoL improvement at six months. Researches are needed to confirm that mental QoL of patients with depressive symptoms can be improved by TAVI.
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Affiliation(s)
- A S Boureau
- Anne Sophie Boureau, MD, Department of Geriatrics, Nantes University Hospital, boulevard Jacques Monod, 44093 Nantes Cedex 1, France; telephone number : + 33 2 40 16 50 46, fax number : +33 2 40 16 53 58, e-mail:
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10
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Lange R, Beckmann A, Neumann T, Krane M, Deutsch MA, Landwehr S, Kötting J, Welz A, Zahn R, Cremer J, Figulla HR, Schuler G, Holzhey DM, Funkat AK, Heusch G, Sack S, Pasic M, Meinertz T, Walther T, Kuck KH, Beyersdorf F, Böhm M, Möllmann H, Hamm CW, Mohr FW. Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:2541-2554. [DOI: 10.1016/j.jcin.2016.09.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
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Frailty Assessed by the Forecast is a Valid Tool to Predict Short-Term Outcome after Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:407-413. [DOI: 10.1097/imi.0000000000000321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The term frailty is frequently used during decision-making in transcatheter heart valve procedures. Nevertheless, frailty is still measured by eyeballing rather than by using standardized frailty assessments. In a previous study, we developed a frailty score in a cardiac surgical patient population including patients, who underwent transcatheter aortic valve replacement (TAVR). Here, we present the results from the subsequent validation study focusing on the TAVR cohort. Methods One hundred thirty patients underwent TAVR. Frailty assessment using the FORECAST (Frailty predicts death One yeaR after Elective CArdiac Surgery Test) was performed. The European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons (STS) score were assessed as well. Follow-up included assessment of in-hospital and 30-day mortality and morbidity and quality of life using the Short Form-36 questionnaire. Results Mean age was 83.3 years, and 50% were female. Logistic European System for Cardiac Operative Risk Evaluation was 14.9 ± 8.7%, and STS score was 5.1 ± 3.4%. Mean ± standard deviation FORECAST score was 4.8 ± 3.3 points of 15. In-hospital and 30-day mortality were 6.9% and 7.7%, respectively. Thirty-day Short Form-36 assessment showed a decrease in quality of life in five of ten items after the intervention. Receiver operating characteristic curves showed that the FORECAST is a valid tool to predict in-hospital mortality (area under the receiver operating characteristic curve, 0.73). By combining the FORECAST and the STS score, this effect was even higher (area under the receiver operating characteristic curve, 0.77; P = 0.021). Stratifying the patients according to the FORECAST score showed best survival in the lowest frailty group. Conclusions The FORECAST is a valid tool to assess frailty in TAVR patients. The FORECAST is easily assessable and can be included in daily clinical routine.
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Kobe AR, Meyer A, Elmubarak H, Kempfert J, Pavicevic J, Maisano F, Walther T, Falk V, Sündermann SH. Frailty Assessed by the Forecast is a Valid Tool to Predict Short-Term Outcome after Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adrian R. Kobe
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hassan Elmubarak
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Jovana Pavicevic
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charite-Universitätsmedizm Berlin, Berlin, Germany
| | - Simon H. Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
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Improvements in quality of life in septuagenarians versus octogenarians undergoing trans-catheter aortic valve replacement. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:439-43. [PMID: 27594873 PMCID: PMC4984562 DOI: 10.11909/j.issn.1671-5411.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement (TAVR) when one considers the potential improvement in the quality of life (QoL) on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. METHODS This prospective cohort study included 136 elderly patients (70 to 89 years of age), who underwent transfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups: septuagenarians (n = 67) and octogenarians (n = 69). Preoperative and early postoperative clinical parameters were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. RESULTS Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association (NYHA) class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group (P = 0.02, 0.01, 0.03, respectively). CONCLUSION Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the QoL and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.
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Olsson K, Nilsson J, Hörnsten Å, Näslund U. Patients' self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement. Eur J Cardiovasc Nurs 2016; 16:213-221. [PMID: 27169460 DOI: 10.1177/1474515116650342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aortic stenosis is the most common valve disease in western countries and has poor prognosis without treatment. Surgical aortic valve replacement (SAVR) is the gold standard, and transcatheter aortic valve implantation (TAVI) is a new method that is used in high-risk patients who are denied surgery. The purpose of treatment is not only to save life, but also to reduce symptoms and increase health-related quality of life (HRQoL). OBJECTIVE The aim of this study was to describe patients' self-reported outcomes in terms of physical function, symptoms, dependence, HRQoL, and cognitive function after TAVI and SAVR. METHODS All patients treated with TAVI during 1 year ( n = 24) and age-matched patients treated with SAVR ( n = 24) were included. Data were collected on the day before and at 6 months after treatment using structural questionnaires. RESULTS Self-rated function was low before treatment and increased at follow-up. A quarter of all patients reported syncope at baseline, and none reported this at follow-up. Breathlessness was reported by all patients to be the most limiting cardiac symptom, but the TAVI patients reported more severe symptoms. At 6 months' follow-up, symptoms were reduced, but breathlessness and fatigue were still common, especially in the TAVI group. HRQoL, which was very low in the TAVI group at baseline, increased in all dimensions except social function. CONCLUSION We found no change in cognitive function or dependence at follow-up. There was no difference in the size of improvement between groups. The results could be helpful when informing future patients in order to give them realistic expectations.
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Affiliation(s)
- Karin Olsson
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,2 Department of Nursing, Umeå University, Umeå, Sweden
| | - Johan Nilsson
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Åsa Hörnsten
- 2 Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Thyregod HGH, Møller CH, Søndergaard L, Gluud C, Steinbrüchel DA. Transcatheter versus optimal medical treatment and surgical aortic valve replacement for aortic valve stenosis. Hippokratia 2015. [DOI: 10.1002/14651858.cd010488.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hans GH Thyregod
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiothoracic Surgery, RT 2152; Blegdamsvej 9 Copenhagen Copenhagen Denmark 2100
| | - Christian H Møller
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiothoracic Surgery; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Lars Søndergaard
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology; Copenhagen Copenhagen Denmark 2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Daniel A Steinbrüchel
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiothoracic Surgery; Blegdamsvej 9 Copenhagen Denmark 2100
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Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: an updated review of literature. Curr Cardiol Rep 2014; 16:473. [PMID: 24585114 DOI: 10.1007/s11886-014-0473-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent trials have highlighted the comparable mortality benefits and durability of the results for patients with severe aortic stenosis (AS) and high surgical risk managed with either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (AVR). Various national guidelines and international regulatory bodies have approved TAVR, thereby leading to potential wide usage and dissemination of this technique worldwide. Quality-of-life outcomes, in spite of being an important measure of success and acceptability of the procedure, have not been publicized as extensively. For high risk patients with severe AS, implementation of TAVR has resulted in comparable survival, but different and novel adverse events compared with AVR. We present an updated review focusing on the quality-of-life outcomes and issues with this new and important procedural approach.
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Timek TA, Turfe Z, Hooker RL, Davis AT, Willekes CL, Murphy ET, Bove TJ, Heiser JC, Patzelt LH. Aortic valve replacement in octogenarians with prior cardiac surgery. Ann Thorac Surg 2014; 99:518-23. [PMID: 25195546 DOI: 10.1016/j.athoracsur.2014.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/26/2014] [Accepted: 08/29/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been advocated for very elderly patients with aortic stenosis, and prior cardiac surgery as a less invasive treatment option. Although surgical aortic valve replacement (AVR) is safe and effective in selected elderly patients, the perioperative and mid-term outcomes of AVR in very elderly with prior cardiac surgery are unknown. METHODS The Society of Thoracic Surgeons (STS) Database at our center enrolled 3,735 patients after AVR since 1997. In this time interval, we identified 61 patients 80 years and older who underwent AVR for severe AS or failed aortic bioprosthesis after having prior cardiac surgery. All clinical parameters were derived from the STS database. Follow-up mortality was assessed using the Social Security Death Index. RESULTS The average age of the patients was 83 ± 2 years, 77% were male, and 75% underwent an isolated coronary artery bypass graft (CABG) as their first cardiac procedure. The mean ejection fraction was 0.53 ± 0.13. The CABG was performed concurrently in 49% of patients at the time of redo sternotomy and AVR. Stented bioprosthesis was implanted in 61% of patients and stentless in 39%. Perioperative mortality was 1.6% (1 of 61). One, 3, 5, and 7 year survival rates were 85%, 69%, 63%, and 43%, respectively. Patients with AVR only had similar survival to patients who underwent concomitant AVR and CABG. Type of aortic prosthesis did not influence postoperative survival. CONCLUSIONS In selected patients over the age of 80 with history of prior cardiac surgery, AVR can be performed safely with very good mid-term outcomes. Age alone should not be exclusion criteria for surgical AVR in octogenarians with prior cardiac surgery.
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Affiliation(s)
- Tomasz A Timek
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
| | - Zaahir Turfe
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Robert L Hooker
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan
| | - Alan T Davis
- Grand Rapids Education Partners, Grand Rapids, Michigan; Department of Surgery, Michigan State University, Grand Rapids, Michigan
| | - Charles L Willekes
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan
| | - Edward T Murphy
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan
| | - Theodore J Bove
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan
| | - John C Heiser
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan
| | - Lawrence H Patzelt
- Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan
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Deutsch MA, Bleiziffer S, Elhmidi Y, Piazza N, Voss B, Lange R, Krane M. Beyond adding years to life: health-related quality-of-life and functional outcomes in patients with severe aortic valve stenosis at high surgical risk undergoing transcatheter aortic valve replacement. Curr Cardiol Rev 2014; 9:281-94. [PMID: 24313648 PMCID: PMC3941091 DOI: 10.2174/1573403x09666131202121750] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 09/28/2012] [Accepted: 10/25/2012] [Indexed: 11/22/2022] Open
Abstract
Aortic valve stenosis (AVS) is the most frequent acquired valvular heart disease in western industrialized countries
and its prevalence considerably increases with age. Once becoming symptomatic severe AVS has a very poor prognosis.
Progressive and rapid symptom deterioration leads to an impairment of functional status and compromised healthrelated
quality-of-life (HrQoL) simultaneously. Until recently, surgical aortic valve replacement (SAVR) has been the
only effective treatment option for improving symptoms and prolonging survival. Transcatheter aortic valve replacement
(TAVR) emerged as an alternative treatment modality for those patients with severe symptomatic AVS in whom the risk
for SAVR is considered prohibitive or too high. TAVR has gained clinical acceptance with almost startling rapidity and
has even quickly become the standard of care for the treatment of appropriately selected individuals with inoperable AVS
during recent years. Typically, patients currently referred for and treated by TAVR are elderly with a concomitant variable
spectrum of multiple comorbidities, disabilities and limited life expectancy. Beyond mortality and morbidity, the assessment
of HrQoL is of paramount importance not only to guide patient-centered clinical decision-making but also to judge
this new treatment modality. As per current evidence, TAVR significantly improves HrQoL in high-surgical risk patients
with severe AVS with sustained effects up to two years when compared with optimal medical care and demonstrates
comparable benefits relative to SAVR. Along with a provision of a detailed overview of the current literature regarding functional and HrQoL outcomes in patients
undergoing TAVR, this review article addresses specific considerations of the HrQoL aspect in the elderly patient
and finally outlines the implications of HrQoL outcomes for medico-economic deliberations.
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Affiliation(s)
| | | | | | | | | | | | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universitat Munchen, Lazarettstrasse 36, 80636 Munich, Germany.
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Elmalem S, Dumonteil N, Marcheix B, Toulza O, Vellas B, Carrie D, Nourhashemi F. Health-Related Quality of Life After Transcatheter Aortic Valve Implantation in Elderly Patients With Severe Aortic Stenosis. J Am Med Dir Assoc 2014; 15:201-206. [DOI: 10.1016/j.jamda.2013.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/02/2013] [Accepted: 11/12/2013] [Indexed: 10/25/2022]
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20
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Egerod I, Nielsen S, Lisby KH, Darmer MR, Pedersen PU. Immediate post-operative responses to transcatheter aortic valve implantation: An observational study. Eur J Cardiovasc Nurs 2014; 14:232-9. [PMID: 24550558 DOI: 10.1177/1474515114525521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/04/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients. AIMS The aim of our study was to describe the post-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age. METHODS A prospective, comparative observational study triangulating nurse assessment and structured interviews on a cohort of 54 Danish patients: 28/26 male/female, 26/28 younger/older than 80. Mean age in the younger/older group was 73/85 years. RESULTS After TAVI pain was experienced by 47 (87%) patients; 29 (62%) were restricted by pain, and 24 (44%) had discomfort at the femoral insertion site. Disturbed sleep/rest were reported by 34 (63%)/29 (55%) patients; nausea/vomiting by 14 (26%)/5 (9%) patients, restricting eating/drinking in 11 (21%)/8 (15%) patients. Sinus rhythm/atrial fibrillation/paced rhythm were observed in 35 (65%)/8 (15%)/21 (39%) patients; bleeding/haematoma/oozing from femoral insertion site in 23 (45%)/10 (19%)/23 (43%) patients. CONCLUSION Patients older than 80 years did as well as the younger patients in our study; the main complaints were post-operative pain and disrupted sleep. Our numbers are small, but most patients experienced considerable pain, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.
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Affiliation(s)
- Ingrid Egerod
- Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Susanne Nielsen
- Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Karen H Lisby
- Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Mette R Darmer
- Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. Functional status and quality of life after transcatheter aortic valve replacement: a systematic review. Ann Intern Med 2014; 160:243-54. [PMID: 24727842 PMCID: PMC4039034 DOI: 10.7326/m13-1316] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. PURPOSE To evaluate the changes in functional status and quality of life after TAVR. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. STUDY SELECTION Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. DATA EXTRACTION Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range 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 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. LIMITATIONS Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. CONCLUSION Transcatheter aortic valve replacement 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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Affiliation(s)
- Caroline A. Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Suraj P. Rasania
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jonathan Afilalo
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey J. Popma
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Lewis A. Lipsitz
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Dae Hyun Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
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Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation. Arch Cardiovasc Dis 2014; 107:10-20. [DOI: 10.1016/j.acvd.2013.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/27/2013] [Accepted: 10/30/2013] [Indexed: 11/21/2022]
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Ho E, Mathur MN, Brady PW, Marshman D, Brereton RJ, Ross DE, Bhindi R, Hansen PS. Surgical aortic valve replacement in very elderly patients aged 80 years and over: evaluation of early clinical outcomes. Heart Lung Circ 2013; 23:242-8. [PMID: 24021233 DOI: 10.1016/j.hlc.2013.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND An increasing number of very elderly patients aged ≥80 years will require aortic valve replacement (AVR) for severe aortic stenosis (AS). Many are classified as high-risk surgical candidates. Transcatheter aortic valve implantation (TAVI) has been proposed as an alternative to surgical AVR (SAVR) for high-risk patients. We evaluated early clinical outcomes of very elderly patients undergoing SAVR to optimise TAVI candidate selection. METHODS We conducted a retrospective case review of 132 consecutive patients aged ≥80 years undergoing isolated SAVR (49 patients) or combined SAVR/CABG (83 patients) during February 2002-January 2010 at a single tertiary referral hospital. Risk for cardiac surgery was calculated using the logistic EuroSCORE (ES(log)). Mortality and morbidity data were collected for the 30-day postoperative period. RESULTS Thirty-day mortality rate was 8.3% for patients undergoing SAVR (6.1% for isolated SAVR and 9.6% for SAVR/CABG). Permanent stroke occurred in 3.8% and renal insufficiency in 7.6% of the cohort. Thirty-five percent of patients had left ventricular ejection fraction <50%, 67% had advanced symptoms (NYHA class III or IV), and 42% of patients were stratified as high-risk (ES(log)≥20%). CONCLUSIONS SAVR can be performed in very elderly patients with acceptable operative morbidity and mortality. The outcomes at our institution are comparable to contemporary SAVR and TAVI outcomes.
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Affiliation(s)
- Edwin Ho
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
| | - Manu N Mathur
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Peter W Brady
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - David Marshman
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Russell J Brereton
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Donald E Ross
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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Thyregod HGH, Møller CH, Søndergaard L, Gluud C, Steinbrüchel DA. Transcatheter versus optimal medical treatment and surgical aortic valve replacement for aortic valve stenosis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shan L, Saxena A, McMahon R, Wilson A, Newcomb A. A systematic review on the quality of life benefits after aortic valve replacement in the elderly. J Thorac Cardiovasc Surg 2013; 145:1173-89. [PMID: 23415689 DOI: 10.1016/j.jtcvs.2013.01.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/18/2012] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical aortic valve replacement is being increasingly performed in elderly patients with good perioperative outcomes and long-term survival. Evidence is limited on health-related quality of life after aortic valve replacement, which is an important measure of operative success in the elderly. METHODS A systematic review of clinical studies after January 2000 was performed to identify health-related quality of life in the elderly after aortic valve replacement. Strict inclusion and exclusion criteria were applied. Quality appraisal of each study also was performed using predefined criteria. Health-related quality of life results were synthesized through a narrative review with full tabulation of the results of all included studies. RESULTS Health-related quality of life improvements were shown across most or all domains in different health-related quality of life instruments. Elderly patients experienced marked symptomatic improvement. Health-related quality of life was equivalent or superior to both an age-matched population and younger patients undergoing identical procedures. There were excellent functional gains after surgery, but elderly patients remain susceptible to geriatric issues and mood problems. Concomitant coronary artery bypass did not affect health-related quality of life. There was a diverse range of study designs, methods, and follow-up times that limited direct comparison between studies. CONCLUSIONS Aortic valve replacement results in significant health-related quality of life benefits across a broad range of health domains in elderly patients. Age alone should not be a precluding factor for surgery. Data are heterogeneous and mostly retrospective. We recommend future studies based on consistent guidelines provided in this systematic review.
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Affiliation(s)
- Leonard Shan
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Georgiadou P, Sbarouni E, Karavolias GK, Voudris V. Transcatheter aortic valve implantation: restoring the qualities of life in old age. Age Ageing 2013; 42:21-6. [PMID: 22910300 DOI: 10.1093/ageing/afs110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a tremendous therapeutic advance for patients with severe aortic stenosis and high-surgical risk. Since TAVI-treated patients are elderly with multiple co-existing conditions, limited life expectancy and disproportionate health-care expenditures, the aspect of the health-related quality of life (HRQoL) benefits becomes of fundamental importance. Based on recent evidence, TAVI appears to improve significantly HRQoL measures compared with optimal standard care, which are restored to age-adjusted population norms over time.
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Affiliation(s)
- Panagiota Georgiadou
- 2nd Division of Interventional Cardiology, Onassis Cardiac Surgery Center, 356 Syngrou Avenue, 176 74, Athens, Greece.
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Deutsch MA, Krane M, Bleiziffer S, Lange R. Health-Related Quality of Life After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2013; 61:108. [DOI: 10.1016/j.jacc.2012.08.1015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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