Assessment of Quality of Life in Patients After Surgical and Transcatheter Aortic Valve Replacement

作者：Tokarek Tomasz^*; Siudak Zbigniew; Dziewierz Artur; Sobczynski Robert; Zasada Wojciech; Sorysz Danuta; Olszewska Witynska Katarzyna; Bryniarski Krzysztof; Krawczyk Ozog Agata; Zabowka Anna; Sadowski Jerzy; Dudek Dariusz

来源：Catheterization and Cardiovascular Interventions, 2016, 88(3): E80-E88.

DOI：10.1002/ccd.26400

• aortic stenosis
• mini-sternotomy
• mini-thoracotomy
• TAVI

Objectives: Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (mini-thoracotomy, mini-sternotomy, MIAVR) have become an appealing alternative to conventional surgical (SAVR) treatment of severe aortic stenosis (AS) in high-risk patients. Background: Aim of the study was to evaluate the quality of life (QoL) in patients with AS and treated with transfemoral TAVI, SAVR, mini-thoracotomy and mini-sternotomy. Methods: One hundred and seventy-three patients with symptomatic AS were enrolled in 2011-2013. TAVI group consisted of 39 patients (22.5%), mini-sternotomy was performed in 44 patients (25.5%), mini-thoracotomy in 50 (29%), and AVR in 40 patients (23%). QoL was assessed perioperatively, 12 and 24 months after aortic valve replacement (AVR) by Minnesota Living with Heart Failure Questionnaire (MLHFQ) and EQ-5D-3L. Results: Median follow-up was 583.5 (IQR: 298-736) days. Improvement of health status after procedure in comparison with preoperative period was significantly more often reported after TAVI in perioperative period (90.3%; P = 0.004) and 12 months after procedure (100%, P = 0.02). Global MLHFQ, physical and emotional dimension score at 30-day from AVR presented significant improvement after TAVI in comparison with surgical methods (respectively: 8.3(+/- 8.6), P = 0.003; 4.1(+/- 5.9), P = 0.01; 1.5(+/- 2.6), P = 0.005). Total MLHFQ score was significantly lower (better outcome) in TAVI patients 1 year after procedure (4.8(+/- 6.8), P = 0.004), no differences in somatic and emotional component were found. No differences were found in MLHFQ score 24 months after AVR. Data from EQ-D5-3L questionnaire demonstrated significant improvement of QoL at 30-day follow-up after TAVI in comparison with surgical methods (1.2(+/- 1.7), P = 0.0008). Conclusions: TAVI improves QoL in perioperative and 12 months observation in comparison with mini-thoracotomy, mini-sternotomy and SAVR. Improvement in QoL was obtained in both generic and disease specific questionnaires.