Quality of Life After Transcatheter Aortic Valve Replacement: Prospective Data From GARY (German Aortic Valve Registry)

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• 作者：Rü ; diger Lange ; MD ; PhD^a ; ^b ; ^{lange@dhm.mhn.de} ; Andreas Beckmann ; MD^c ; Till Neumann ; MD^d ; Markus Krane ; MD^a ; ^b ; Marcus-André ; Deutsch ; MD^a ; Sandra Landwehr ; PhD^e ; Joachim Kö ; tting ; DiplStat^e ; Armin Welz ; MD^f ; Ralf Zahn ; MD^g ; Jochen Cremer ; MD^h ; Hans R. Figulla ; MDⁱ ; Gerhard Schuler ; MD^j ; David M. Holzhey ; MD^j ; Anne-Kathrin Funkat ; PhD^j ; Gerd Heusch ; MD ; PhD^k ; Stefan Sack ; MD^l ; Miralem Pasic ; MD^m ; Thomas Meinertz ; MDⁿ ; Thomas Walther ; MD^o ; Karl-Heinz Kuck ; MD^p ; Friedhelm Beyersdorf ; MD^q ; Michael Bö ; hm ; MD^r ; Helge Mö ; llmann ; MD^s ; Christian W. Hamm ; MD^s ; Friedrich W. Mohr ; MD^j ; for the GARY Executive Board
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：26 December 2016
• 年：2016
• 卷：9
• 期：24
• 页码：2541-2554
• 全文大小：1322 K
• 卷排序：9

文摘

This study sought to analyze health-related quality-of-life (HrQoL) outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) based on data from GARY (German Aortic Valve Registry).BackgroundTypically, 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 in this high-risk patient population.MethodsIn 2011, 3,875 patients undergoing TAVR were included in the GARY registry. HrQoL was prospectively measured using the EuroQol 5 dimensions questionnaire self-complete version on paper at baseline and 1 year.ResultsComplete follow-up EuroQol 5 dimensions questionnaire evaluation was available for 2,288 patients (transvascular transcatheter aortic valve replacement [TAVR-TV]: n = 1,626 and transapical TAVR [TAVR-TA]: n = 662). In-hospital mortality was 5.9% (n = 229) and the 1-year mortality was 23% (n = 893). The baseline visual analog scale score for general health status was 52.6% for TAVR-TV and 55.8% for TAVR-TA and, in parallel to an improvement in New York Heart Association functional class, improved to 59.6% and 58.5% at 1 year, respectively (p < 0.001). Between baseline and 1 year, the number of patients reporting no complaints increased by 7.8% (TAVR-TV) and by 3.5% within the mobility dimension, and by 14.1% (TAVR-TV) and 9.2% within the usual activity dimension, whereas only moderate changes were found for the self-care, pain or discomfort, and anxiety or depression dimensions. In a multiple linear regression analysis several pre- and post-operative factors were predictive for less pronounced HrQoL benefits.ConclusionsTAVR treatment led to improvements in HrQoL, especially in terms of mobility and usual activities. The magnitude of improvements was higher in the TAVR-TV group as compared to the TAVR-TA group. However, there was a sizable group of patients who did not derive any HrQoL benefits. Several independent pre- and post-operative factors were identified being predictive for less pronounced HrQoL benefits.