Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients

Neal S. Kleiman; Nicolas M. Van Mieghem; Michael J. Reardon; Hemal Gada; Mubashir Mumtaz; Peter Skov Olsen; John Heiser; William Merhi; Stanley Chetcuti; G. Michael Deeb; Atul Chawla; Bob Kiaii; Patrick Teefy; Michael W.A. Chu; Steven J. Yakubov; Stephan Windecker; Andrew D. Althouse; Suzanne J. Baron

doi:10.1016/j.jcin.2024.02.014

Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients

Neal S. Kleiman, Nicolas M. Van Mieghem, Michael J. Reardon, Hemal Gada, Mubashir Mumtaz, Peter Skov Olsen, John Heiser, William Merhi, Stanley Chetcuti, G. Michael Deeb, Atul Chawla, Bob Kiaii, Patrick Teefy, Michael W.A. Chu, Steven J. Yakubov, Stephan Windecker, Andrew D. Althouse, Suzanne J. Baron

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background: Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. Objectives: The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. Methods: Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. Results: Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. Conclusions: In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups.

Original language	English (US)
Pages (from-to)	979-988
Number of pages	10
Journal	JACC: Cardiovascular Interventions
Volume	17
Issue number	8
DOIs	https://doi.org/10.1016/j.jcin.2024.02.014
State	Published - Apr 22 2024

Keywords

Kansas City Cardiomyopathy Questionnaire
quality of life
surgical aortic valve replacement
transcatheter aortic valve replacement

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jcin.2024.02.014

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Kleiman, N. S., Van Mieghem, N. M., Reardon, M. J., Gada, H., Mumtaz, M., Olsen, P. S., Heiser, J., Merhi, W., Chetcuti, S., Deeb, G. M., Chawla, A., Kiaii, B., Teefy, P., Chu, M. W. A., Yakubov, S. J., Windecker, S., Althouse, A. D., & Baron, S. J. (2024). Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC: Cardiovascular Interventions, 17(8), 979-988. https://doi.org/10.1016/j.jcin.2024.02.014

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 2024, 'Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients', JACC: Cardiovascular Interventions, vol. 17, no. 8, pp. 979-988. https://doi.org/10.1016/j.jcin.2024.02.014

@article{a092b0402ffd46b09ee51a30091c279d,

title = "Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients",

abstract = "Background: Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. Objectives: The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. Methods: Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. Results: Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. Conclusions: In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups.",

keywords = "Kansas City Cardiomyopathy Questionnaire, quality of life, surgical aortic valve replacement, transcatheter aortic valve replacement",

author = "Kleiman, \{Neal S.\} and \{Van Mieghem\}, \{Nicolas M.\} and Reardon, \{Michael J.\} and Hemal Gada and Mubashir Mumtaz and Olsen, \{Peter Skov\} and John Heiser and William Merhi and Stanley Chetcuti and Deeb, \{G. Michael\} and Atul Chawla and Bob Kiaii and Patrick Teefy and Chu, \{Michael W.A.\} and Yakubov, \{Steven J.\} and Stephan Windecker and Althouse, \{Andrew D.\} and Baron, \{Suzanne J.\}",

note = "Publisher Copyright: {\textcopyright} 2024 American College of Cardiology Foundation",

year = "2024",

month = apr,

day = "22",

doi = "10.1016/j.jcin.2024.02.014",

language = "English (US)",

volume = "17",

pages = "979--988",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "8",

}

TY - JOUR

T1 - Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients

AU - Kleiman, Neal S.

AU - Van Mieghem, Nicolas M.

AU - Reardon, Michael J.

AU - Gada, Hemal

AU - Mumtaz, Mubashir

AU - Olsen, Peter Skov

AU - Heiser, John

AU - Merhi, William

AU - Chetcuti, Stanley

AU - Deeb, G. Michael

AU - Chawla, Atul

AU - Kiaii, Bob

AU - Teefy, Patrick

AU - Chu, Michael W.A.

AU - Yakubov, Steven J.

AU - Windecker, Stephan

AU - Althouse, Andrew D.

AU - Baron, Suzanne J.

PY - 2024/4/22

Y1 - 2024/4/22

N2 - Background: Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. Objectives: The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. Methods: Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. Results: Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. Conclusions: In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups.

AB - Background: Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. Objectives: The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. Methods: Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. Results: Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. Conclusions: In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups.

KW - Kansas City Cardiomyopathy Questionnaire

KW - quality of life

KW - surgical aortic valve replacement

KW - transcatheter aortic valve replacement

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U2 - 10.1016/j.jcin.2024.02.014

DO - 10.1016/j.jcin.2024.02.014

M3 - Article

C2 - 38658126

AN - SCOPUS:85189976715

SN - 1936-8798

VL - 17

SP - 979

EP - 988

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 8

ER -

Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients

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