Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis.

Abstract

BACKGROUND:

In patients with severe aortic stenosis (AS) at low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) results in lower rates of death, stroke, and rehospitalization at 1 year compared with surgical aortic valve replacement; however, the effect of treatment strategy on health status is unknown.

OBJECTIVES:

This study sought to compare health status outcomes of TAVR versus surgery in low-risk patients with severe AS.

METHODS:

Between March 2016 and October 2017, 1,000 low-risk patients with AS were randomized to transfemoral TAVR using a balloon-expandable valve or surgery in the PARTNER 3 (Placement of Aortic Transcatheter Valves) trial. Health status was assessed at baseline and 1, 6, and 12 months using the KCCQ (Kansas City Cardiomyopathy Questionnaire), SF-36 (Short Form-36 Health Survey), and EQ-5D (EuroQoL). The primary endpoint was change in KCCQ-OS (KCCQ Overall Summary) score over time. Longitudinal growth curve modeling was used to compare changes in health status between treatment groups over time.

RESULTS:

At 1 month, TAVR was associated with better health status than surgery (mean difference in KCCQ-OS 16.0 points; p < 0.001). At 6 and 12 months, health status remained better with TAVR, although the effect was reduced (mean difference in KCCQ-OS 2.6 and 1.8 points respectively; p < 0.04 for both). The proportion of patients with an excellent outcome (alive with KCCQ-OS ≥75 and no significant decline from baseline) was greater with TAVR than surgery at 6 months (90.3% vs. 85.3%; p = 0.03) and 12 months (87.3% vs. 82.8%; p = 0.07).

CONCLUSIONS:

Among low-risk patients with severe AS, TAVR was associated with meaningful early and late health status benefits compared with surgery.

• Authors: Suzanne J Baron, Elizabeth A Magnuson, Michael Lu, Kaijun Wang, Khaja Chinnakondepalli, Michael Mack, Vinod H Thourani, Susheel Kodali, Raj Makkar, Howard C Herrmann, Samir Kapadia, Vasilis Babaliaros, Mathew R Williams, Dean Kereiakes, Alan Zajarias, Maria C Alu, John G Webb, Craig R Smith, Martin B Leon, David J Cohen, PARTNER 3 Investigators
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 74 Issue 23 Pg. 2833-2842 (12 10 2019) ISSN: 1558-3597 [Electronic] United States
• PMID: 31577923 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aortic Valve (surgery)
• Aortic Valve Stenosis (diagnosis, surgery)
• Echocardiography
• Female
• Follow-Up Studies
• Health Status
• Heart Valve Prosthesis
• Humans
• Male
• Prospective Studies
• Quality of Life
• Severity of Illness Index
• Transcatheter Aortic Valve Replacement (methods)
• Treatment Outcome