Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have demonstrated similar outcomes in symptomatic aortic stenosis patients (at high or intermediate risk) in terms of 5-year survival.
When evaluating the quality of life (QoL) of these two treatment strategies in patients with high surgical risk, there were no significant differences at 5 years. Based on this premise, the group led by N. Kleiman analyzed the follow-up results of the SURTAVI study.
The SURTAVI study included patients with an intermediate risk of mortality at 30 days according to the STS score, who were randomly assigned to TAVR with a self-expanding valve or surgery. Their health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), validated for patients with aortic stenosis, in addition to the 5EQ and SF-36 scores.
Among the 1660 patients enrolled in the SURTAVI study, researchers compared data from 805 patients undergoing TAVR (transfemoral access only) and 779 undergoing SAVR. Compared with baseline, patients undergoing TAVR showed significant improvement at 30 days, as measured with the KCCQ (average change of 19 points, 95% confidence interval [CI]: 17.4–20.6; P <0.001). This difference persisted at 5 years, albeit with a smaller effect (average change of 15.4 points; 95% CI: 13.0–17.7; P <0.001).
Read also: TAVR in Bicuspid Valves.
Patients treated with SAVR only experienced slight improvement at 30 days (average change of 5.9 points; 95% CI: 3.9–7.9; P <0.001). However, this improvement increased at 6 months and remained stable for 5 years (average change of 21.3; 95% CI: 19.6–23.0; P <0.001). The 5D and SF-36 scores showed similar trends.
When analyzing the groups, there was a significant difference at 30 days in the change in KCCQ-OS between TAVR and SAVR (difference 13.11; P <0.01). However, this difference leveled off when evaluating the results at 6 months (difference –0.41; P = 0.75). When evaluating days alive and out of the hospital (DAOH), the mean days were significantly higher in the TAVR group (1459 ± 558 days vs 1384 ± 599 days; P = 0.01).
Conclusions
Patients undergoing TAVI and SAVR experienced significant improvements in health status compared with their baseline. As expected, the improvement in QoL was greater at 30 days in the TAVR group, but it leveled off at 6 months and remained constant during the 5-year follow-up.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Original Title: Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients.
Reference: Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, Heiser J, Merhi W, Chetcuti S, Deeb GM, Chawla A, Kiaii B, Teefy P, Chu MWA, Yakubov SJ, Windecker S, Althouse AD, Baron SJ. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv. 2024 Apr 22;17(8):979-988. doi: 10.1016/j.jcin.2024.02.014. PMID: 38658126.
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