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Gonnah AR, Abdelwahab M, Taylor R, Labib A, Masoud O, Debski M, Abdelaziz HK, Roberts DH. Health-related quality of life following TAVI or cardiac surgery in patients at intermediate and low risk: a systematic review and meta-analysis. Clin Med (Lond) 2023; 23:594-605. [PMID: 38065591 PMCID: PMC11046617 DOI: 10.7861/clinmed.2023-0258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Recent randomised trials have shown that clinical outcomes with transcatheter aortic valve implantation (TAVI) are non-inferior to surgical aortic valve replacement (SAVR) in patients with symptomatic aortic stenosis at intermediate to low risk. Health-related quality of life (HrQoL) outcomes in these patient groups remain uncertain. A systematic search of the literature was conducted that included nine trials and 11,295 patients. Kansas City Cardiomyopathy Questionnaire (KCCQ), a heart-failure-specific measure and EuroQol-5D (EQ-5D) (a generic health status tool) changes were the primary outcomes. New York Heart Association (NYHA) classification was the secondary outcome. Improvement in KCCQ scores was greater with TAVI (mean difference (MD)=13.56, 95% confidence interval (CI) 11.67-15.46, p<0.001) at 1 month, as was the improvement in EQ-5D (MD=0.07, 95% CI 0.05-0.08, p<0.001). There was no difference in KCCQ (MD=1.05, 95% CI -0.11 to 2.21, p=0.08) or EQ-5D (MD=-0.01, 95% CI -0.03 to 0.01), p=0.37) at 12 months. NYHA functional class 3/4 was lower in patients undergoing TAVI at 1 month (MD=0.51, 95% CI 0.34-0.78, p=0.002), but there was no difference at 12 months (MD=1.10; 95% CI 0.87-1.38, p=0.43). Overall, TAVI offers early benefit in HRQoL outcomes compared with SAVR, but they are equivalent at 12 months.
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Affiliation(s)
| | | | - Rebecca Taylor
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Aser Labib
- Southport and Ormskirk NHS Foundation Trust, Southport, UK
| | - Omar Masoud
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Maciej Debski
- University of East Anglia, Norwich, UK and research fellow, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - David Hesketh Roberts
- Lancashire Cardiac Centre, Blackpool, UK, and honorary senior lecturer, University of Liverpool, Merseyside Liverpool
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Bartos PV, Molnar B, Herold Z, Dekany G, Piroth Z, Horvath G, Ahres A, Heesch CM, Czobor NR, Satish S, Pinter T, Fontos G, Andreka P. Short- and Medium-Term Outcomes Comparison of Native- and Valve-in-Valve TAVI Procedures. Rev Cardiovasc Med 2023; 24:255. [PMID: 39076381 PMCID: PMC11270067 DOI: 10.31083/j.rcm2409255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/01/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2024] Open
Abstract
Background In high-risk patients with degenerated aortic bioprostheses, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a less invasive alternative to surgical valve replacement. To compare outcomes of ViV and native valve (NV) TAVI procedures. Methods 34 aortic ViV-TAVI performed between 2012 and 2022 using self-expanding valves, were included in this retrospective analysis. Propensity score matching (1:2 ratio, 19 criteria) was used to select a comparison NV-TAVI group from a database of 1206 TAVI procedures. Clinical and echocardiographic endpoints, short- and long-term all-cause mortality (ACM) and cardiovascular mortality (CVM) data were obtained. Subgroup analyses were completed according to the true internal diameter, dividing patients into a small ( ≤ 19 mm) valve group (SVG) and a large ( > 19 mm) valve group (LVG). Results Clinical outcomes of ViV- and NV-TAVI were comparable, including device success [88.2% vs. 91.1%, p = 0.727], major adverse cardiovascular and cerebrovascular events [5.8% vs. 5.8%, p = 1.000], hemodialysis need [5.8% vs. 2.9%, p = 0.599], pacemaker need [2.9% vs. 11.7%, p = 0.265], major vascular complications [2.9% vs. 1.4%, p = 1.000], life-threatening or major bleeding [2.9% vs. 1.4%, p = 1.000] and in-hospital mortality [8.8% vs. 5.9%, p = 0.556]. There was a significant difference in the immediate post-intervention mean residual aortic valve gradient (MAVG) [14.6 ± 8.5 mm Hg vs. 6.4 ± 4.5 mm Hg, p < 0.0001], which persisted at 1 year [p = 0.0002]. There were no differences in 12- or 30-month ACM [11.8% vs. 8.8%, p = 0.588; 23.5% vs. 27.9%, p = 0.948], and CVM [11.8% vs. 7.3%, p = 0.441; 23.5% vs. 16.2%, p = 0.239]. Lastly, there was no difference in CVM at 1 year and 30 months [11.1% vs. 12.5%, p = 0.889; 22.2% vs. 25.0%, p = 0.742]. Conclusions Analyzing a limited group (n = 34) of ViV-TAVI procedures out of 1206 TAVIs done at a single institution, ViV-TAVI appeared to be an acceptable approach in patients not deemed appropriate candidates for redo valve replacement surgery. Clinical outcomes of ViV-TAVI were comparable to TAVI for native valve stenosis.
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Affiliation(s)
- Peter V. Bartos
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Balazs Molnar
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Gabor Dekany
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Zsolt Piroth
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Gergely Horvath
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Abdelkrim Ahres
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Christian M Heesch
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Department of Interventional Cardiology, Florida Heart Clinic, Hallandale Beach, FL 33009, USA
| | - Nikoletta R. Czobor
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Sai Satish
- Department of Interventional Cardiology, Apollo Hospital, 600006 Chennai, India
| | - Tunde Pinter
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Geza Fontos
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Peter Andreka
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
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