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Transcatheter aortic valve replacement (TAVR) has emerged as a safe and efficacious alternative to surgical treatment in high-risk or inoperable patients with symptomatic, severe aortic stenosis (NEJM JW Cardiol Jun 8 2011). To assess functional status and quality of life after TAVR, investigators conducted a systematic review of 60 observational studies and 2 randomized, controlled trials involving 11,205 TAVR patients.
In 56 pre- and post-TAVR comparisons, mean age ranged from 73 to 93, female sex ranged from 14% to 94%, and baseline New York Heart Association (NYHA) class III or IV symptoms ranged from 54% to 100%. Most studies showed a decrease of ≥1 in NYHA class at 6 to 11 months and at 12 to 23 months. Increases in the physical component of the Short Form-12/36 score were clinically meaningful (≥2.5 points) at 12 months; changes in the mental component were generally positive but smaller than changes in the physical component. Clinically meaningful improvements were found in other disease-specific measures (e.g., Kansas City Cardiomyopathy Questionnaire) but were not consistently seen in general-health measures (e.g., EuroQol-5D).
Kim CA et al. Functional status and quality of life after transcatheter aortic valve replacement: A systematic review. Ann Intern Med 2014 Feb 18; 160:243.
Comment
The patient characteristics and degree of improvement in functional outcomes varied considerably among the studies in this review. Overall trends toward improvement were seen in symptoms, physical function, and disease-specific quality-of-life measures with transcatheter aortic valve replacement. However, improvements in psychological and general-health measures were small and inconsistent. TAVR increases survival in symptomatic patients who are not candidates for surgery. Nonetheless, well-designed, prospective studies of quality-of-life and functional outcomes are needed to identify patients who will truly feel better after the procedure.