Functional Status After Transcatheter and Surgical Aortic Valve Replacement: 2-Year Analysis From the SURTAVI Trial.

Abstract

OBJECTIVES:

This study sought to evaluate patient-centered metrics in intermediate-surgical-risk aortic stenosis patients enrolled in the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial treated with self-expanding transcatheter aortic valve replacement (TAVR) or surgery.

BACKGROUND:

Studies have shown TAVR to be an alternative to surgery in patients with severe symptomatic aortic stenosis but have focused on "hard endpoints," including all-cause mortality and stroke, rather than on comparative patient-centered metrics, such as functional status and symptom burden.

METHODS:

The study analyzed functional status (6-minute walk test [6MWT]) and symptom burden (Kansas City Cardiomyopathy Questionnaire) in 1,492 patients from the SURTAVI trial at baseline, 30 days, 1 year, and 2 years. Patients were categorized by baseline functional status into tertiles of slow, medium, and fast walkers.

RESULTS:

Patients with lowest capacity baseline functional status were commonly women, had higher Society of Thoracic Surgeons scores, and had more New York Heart Association functional class III or IV symptoms; reduced baseline functional status was associated with higher aortic valve- and heart failure-related hospitalization at 2 years. There was greater improvement in 6MWT distance in TAVR compared with surgery patients at 30 days (P < 0.001) and 1 year (P = 0.012), but at 2 years, both groups had similar improvement (P = 0.091). The percentage of patients with large improvement in 6MWT was greatest in patients categorized as slow walkers and lowest in fast walkers. Symptom burden improved after TAVR at 30 days and after both procedures at 1 and 2 years.

CONCLUSIONS:

In this substudy of patients from the SURTAVI trial, patients receiving TAVR demonstrated a more rapid improvement in functional status and symptom burden compared with patients undergoing surgery; however, both groups had similar improvements in long-term follow-up. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).

• Authors: Mark K Tuttle, Bob Kiaii, Nicolas M Van Mieghem, Roger J Laham, G Michael Deeb, Stephan Windecker, Stanley Chetcuti, Steven J Yakubov, Atul Chawla, David Hockmuth, Patrick Teefy, Shuzhen Li, Michael J Reardon
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 15 Issue 7 Pg. 728-738 (04 11 2022) ISSN: 1876-7605 [Electronic] United States
• PMID: 35393106 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aortic Valve (diagnostic imaging, surgery)
• Aortic Valve Stenosis (diagnostic imaging, surgery)
• Female
• Functional Status
• Heart Valve Prosthesis
• Humans
• Risk Factors
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome