Health-Related Quality of Life After Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis: Results From the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A)

• Published in: Journal of the American College of Cardiology Vol. 60; no. 6; pp. 548 - 558
• Main Authors: REYNOLDS, Matthew R, MAGNUSON, Elizabeth A, COHEN, David J, KAIJUN WANG, THOURANI, Vinod H, WILLIAMS, Mathew, ZAJARIAS, Alan, RIHAL, Charanjit S, BROWN, David L, SMITH, Craig R, LEON, Martin B
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 07-08-2012
• Subjects: Aged, 80 and over; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiology. Vascular system; Endocardial and cardiac valvular diseases; Female; Health Status; Heart; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Humans; Male; Medical sciences; Quality of Life; Severity of Illness Index; Surveys and Questionnaires; Human; High risk; Aortic stenosis; Health; Cardiovascular disease; Patient; Replacement; Quality of life; Result; Treatment; Cardiac valvular disease; Surgery; Circulatory system; Cardiology; Severe; Aortic valve
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2012.03.075

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).
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.
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.
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.
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).