Health-Related Quality of Life After Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis
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Objectives This study sought to compare health status and quality-of-life outcomes for patients with severe aortic stenosis (AS) and high surgical risk treated with either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (AVR).Background For high-risk patients with severe AS, TAVR has been shown to result in similar 12-month survival but differing adverse events compared with AVR.Methods We evaluated the health status of 628 patients with severe, symptomatic AS at high risk of surgical complications who were randomized to either TAVR or AVR in the PARTNER Trial. Health status was assessed at baseline and 1, 6, and 12 months using the Kansas City Cardiomyopathy Questionnaire, the Short Form-12, and the EuroQol-5D.Results The primary outcome, the Kansas City Cardiomyopathy Questionnaire summary score, improved more rapidly with TAVR, but was similar for the 2 groups at 6 and 12 months. However, there was a significant interaction between the benefit of TAVR and access site (transapical vs. transfemoral). Patients eligible for transfemoral TAVR demonstrated significant health status benefits with TAVR versus AVR at 1 month (difference, 9.9 points; 95% confidence interval: 4.9 to 14.9; p < 0.001), whereas patients treated via the TA approach demonstrated no benefits with TAVR compared with AVR at any time point. Results for Kansas City Cardiomyopathy Questionnaire subscales and generic measures demonstrated similar patterns.Conclusions In high-risk patients with severe AS, health status improved substantially between baseline and 1 year after either TAVR or AVR. TAVR via the transfemoral, but not the transapical route, was associated with a short-term advantage compared with surgery. (Placement of AoRTic TraNscathetER Valve [PARTNER] trial; NCT00530894).
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In older patients at high or extreme surgical risk undergoing TAVR, disease-specific and generic health status are often extremely poor.
“In older patients at high or extreme surgical risk undergoing TAVR, disease-specific and generic health status are often extremely poor221;224;244;245.”
From Calcific aortic stenosis (2016) · cites this paper as [245]
The baseline health-status table (p. 551) shows poor disease-specific KCCQ scores and generic physical-health scores in elderly, high-surgical-risk patients assigned to TAVR. The paper does not study an extreme-risk cohort, and its generic mental-health scores are near the population norm, so it does not support describing all generic health status as extremely poor. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn general, TAVR is associated with a survival advantage compared with conservative management without aortic valve replacement.
“Although, in general, TAVR is associated with a survival advantage compared to conservative (no AVR) management”
From Calcific aortic stenosis (2016) · cites this paper as [245]
The introductory passage labeled Abstract reports that TAVR greatly improved survival compared with standard therapy, but specifies that this was in patients who were not candidates for surgery. The claim presents the survival advantage as general; this paper’s own Cohort A comparison was TAVR versus surgical AVR, not conservative management. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA sizable subgroup dies soon after TAVR or does not experience improved quality of life, suggesting potential futility of TAVR in some patients.
“there is a sizable sub-group that dies soon after TAVR or does not experience an improvement in quality of life, suggesting potential futility of TAVR in some patients201;202;220;244;245.”
From Calcific aortic stenosis (2016) · cites this paper as [245]
The categorical results report that 68.3% of transfemoral TAVR patients had at least a small quality-of-life improvement at one month, supporting the point that a substantial proportion did not. The paper does not establish that a sizable subgroup died soon after TAVR, and its finding of no transapical TAVR advantage over surgery should not be read as no improvement from baseline. The suggested futility is therefore not established by this source alone. (LLM, conf=0.84)
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Self-citation
- Authors
- Reynolds, M. R., Magnuson, E. A., Wang, K., Thourani, V. H., Williams, M., Zajarias, A., Rihal, C. S., Brown, D. L., Smith, C. R., Leon, M. B., & Cohen, D. J.
- Affiliations
- Harvard University (US)
- Saint Luke's Hospital (US)
- Emory University Hospital (US)
- NewYork–Presbyterian Hospital (US)
- Mayo Clinic (US)
- Medical City Dallas Hospital (US)
- Corresponding author
- Cohen, David J.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 60
- Issue
- 6
- Pages
- 548-558
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W49484717
- Cited by
- 295
- References
- 33
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 14 · 2023: 15 · 2022: 14 · 2021: 16 · 2020: 15 · 2019: 19 · 2018: 23 · 2017: 22 · 2016: 37 · 2015: 26 · 2014: 24 · 2013: 39 · 2012: 15
- FWCI
- 21.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Boston Scientific Corporation
- Medtronic
- Abbott Vascular
- St. Jude Medical
- Eli Lilly and Company
- AstraZeneca
- Edwards Lifesciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
- Keywords
- transcatheter aortic valve implantation, surgical aortic valve replacement, severe aortic stenosis, high surgical risk, health-related quality of life, health status, transapical approach, transfemoral access, PARTNER trial, Kansas City Cardiomyopathy Questionnaire, EuroQol-5D, SF-12
- MeSH terms
- Aged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Female, Health Status, Heart Valve Prosthesis, Humans, Male, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Heart Valve Prosthesis Implantation
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