Author + information
- Jeffrey J. Popma1,
- Nicolas Van Mieghem2,
- Michael J. Reardon3,
- A. Pieter Kappetein4,
- Steven Yakubov5,
- G. Michael Deeb6,
- Stanley Chetcuti7,
- Mubashir Mumtaz8,
- Hemal Gada9,
- William Merhi10,
- John Heiser11 and
- Patrick Serruys12
- 1Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 2Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 3Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, United States
- 4Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 5Riverside Methodist Hospital, Columbus, Ohio, United States
- 6University of Michigan Hospitals, Ann Arbor, Michigan, United States
- 7University of Michigan Health Center, Ann Arbor, Michigan, United States
- 8PinnacleHealth, Harrisburg, Pennsylvania, United States
- 9PinnacleHealth CardioVascular Institute, Wormleysburg, Pennsylvania, United States
- 10West Michigan Cardiology, Grand Rapids, Michigan, United States
- 11West Michigan Cardiothoracic Surgeons (WMCTS), Grand Rapids, Michigan, United States
- 12Imperial College, London, United Kingdom
Transcatheter aortic valve replacement (TAVR) is an alternative to surgery (SAVR) in patients deemed intermediate risk for surgery based on noninferior outcomes of all-cause mortality or disabling stroke. While more rapid recovery was observed in TAVR patients, delineation of precise health outcomes through 1 year has not been reported.
We compared the 1-year health status of 1,660 patients with symptomatic severe aortic stenosis deemed intermediate risk for surgery who were randomized to self-expanding TAVR or surgery. Health metrics including New York Heart Association (NYHA), 6-minute walk test (6MW), Kansas City Cardiomyopathy Questionnaire (KCCQ), Short Form-36 (SF-36) Physical and Mental Scores, and the EuroQol 5 dimensions questionnaire (ED-5D) were obtained at baseline (BL) and at intervals through 1 year. Measurements at follow-up were compared to BL.
Health outcomes through 1 year were available in 864 patients treated with TAVR and in 796 patients treated with SAVR (Table). Follow-up for the KCCQ was available in 92.5% of eligible patients at 30 days and 71.0% at 1 year. The SF-36 physical component was superior for TAVR at 3 months (7±11 vs 6±11; p<0.05).
|Δ 30 Days from BL||Δ 1 Year from BL|
|6 MW, m||36±100||-14±109+||37±98||18±103+|
We conclude that in intermediate surgical risk severe aortic stenosis patients: (1) health outcomes are improved at 30 days, (2) incremental physical improvements are better at 3 months, and (3) 6-minute walk tests were longer to 1 year in patients treated with TAVR as compared with surgery. Thereafter, health outcomes were similar in both groups and were sustained 1 year after aortic valve replacement.
STRUCTURAL: Valvular Disease: Aortic