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Fradejas-Sastre V, Parás-Bravo P, Herrero-Montes M, Paz-Zulueta M, Boixadera-Planas E, Fernández-Cacho LM, Veiga-Fernández G, Arnáiz-García ME, De-la-Torre-Hernández JM. Surgical vs. transcatheter aortic valve replacement in patients over 75 years with aortic stenosis: sociodemographic profile, clinical characteristics, quality of life and functionality. PeerJ 2023; 11:e16102. [PMID: 37780383 PMCID: PMC10538279 DOI: 10.7717/peerj.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background Aortic valve stenosis (AVS) affects 25% of the population over 65 years. At present, there is no curative medical treatment for AVS and therefore the surgical approach, consisting of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), is the treatment of choice. Methodology The aim of this study was to analyze the sociodemographic and clinical characteristics, quality of life and functionality of a sample of patients with AVS over 75 years of age, who underwent TAVR or SAVR, applying standard clinical practice. A prospective multicenter observational study was conducted in two hospitals of the Spanish National Health System. Data were collected at baseline, 1, 6 months and 1 year. Results In total, 227 participants were included, with a mean age of 80.6 [SD 4.1]. Statistically significant differences were found in terms of quality of life, which was higher at 1 year in patients who underwent SAVR. In terms of functionality, SAVR patients obtained a better score (p < 0.01). However, patients who underwent TAVR began with a worse baseline situation and managed to increase their quality of life and functionality after 1 year of follow-up. Conclusion The individualized choice of TAVR or SAVR in patients with AVS improves patients' quality of life and function. Moreover, the TAVR procedure in patients with a worse baseline situation and a high surgical risk achieved a similar increase in quality of life and functionality compared to patients undergoing SAVR with a better baseline situation.
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Affiliation(s)
- Víctor Fradejas-Sastre
- Nursing Department, Universidad de Cantabria, Santander, Cantabria, Spain
- Interventional Cardiology and Hemodynamics Unit, Hospital Universitario Marqués de Valdecilla, Spain, Santander, Cantabria, Spain
- Research Group in Cardiovascular, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Paula Parás-Bravo
- Nursing Department, Universidad de Cantabria, Santander, Cantabria, Spain
- Nursing Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Manuel Herrero-Montes
- Nursing Department, Universidad de Cantabria, Santander, Cantabria, Spain
- Nursing Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - María Paz-Zulueta
- Nursing Department, Universidad de Cantabria, Santander, Cantabria, Spain
- Research Group in Health Law and Bioethics, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Ester Boixadera-Planas
- Servei d’Estadística Aplicada, Universidad Autonoma de Barcelona, Barcelona, Cataluña, Spain
| | | | - Gabriela Veiga-Fernández
- Interventional Cardiology and Hemodynamics Unit, Hospital Universitario Marqués de Valdecilla, Spain, Santander, Cantabria, Spain
- Research Group in Cardiovascular, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Maria Elena Arnáiz-García
- Cardiac Surgery Service, Hospital Universitario de Salamanca, Spain, Salamanca, Castilla y Leon, Spain
| | - Jose María De-la-Torre-Hernández
- Interventional Cardiology and Hemodynamics Unit, Hospital Universitario Marqués de Valdecilla, Spain, Santander, Cantabria, Spain
- Research Group in Cardiovascular, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
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Frank D, Kennon S, Bonaros N, Romano M, Di Mario C, van Ginkel DJ, Bor W, Kasel M, De Backer O, Hachaturyan V, Lüske CM, Kurucova J, Bramlage P, Styra R. Quality of Life Measures in Aortic Stenosis Research: A Narrative Review. Cardiology 2023; 148:556-570. [PMID: 37442111 PMCID: PMC10733944 DOI: 10.1159/000531465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Elderly patients with aortic stenosis (AS) not only have a reduced life expectancy but also a reduced quality of life (QoL). The benefits of an AS intervention may be considered a balance between a good QoL and a reasonably extended life. However, the different questionnaires being used to determine the QoL were generally not developed for the specific situation of patients with AS and come with strengths and considerable weaknesses. The objective of this article was to provide an overview of the available QoL instruments in AS research, describe their strengths and weaknesses, and provide our assessment of the utility of the available scoring instruments for QoL measurements in AS. SUMMARY We identified and reviewed the following instruments that are used in AS research: Short Form Health Survey (SF-36/SF-12), EuroQol-5D (EQ-5D), the Illness Intrusiveness Rating Scale (IIRS), the HeartQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHF), the MacNew Questionnaire, and the Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ). KEY MESSAGES There is no standardized assessment of QoL in patients with AS. Many different questionnaires are being used, but they are rarely specific for AS. There is a need for AS-specific research into the QoL of patients as life prolongation may compete for an improved QoL in this elderly patient group.
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Affiliation(s)
- Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Critical Care), UKSH University Clinical Center Schleswig-Holstein and DZHK (German Centre for Cardiovascular Research), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wilbert Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Markus Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ole De Backer
- Interventional Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
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Olszewska-Turek K, Bętkowska-Korpała B. Quality of Life and Depressive Symptoms in Transcatheter Aortic Valve Implementation Patients-A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10112211. [PMID: 36360552 PMCID: PMC9690735 DOI: 10.3390/healthcare10112211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Quality of life is an important factor influencing mood. In any group of elderly people undergoing valve implementation or surgical aortic valve replacement, one in three will have depressive symptoms. The aims of this study were as follows: 1. to evaluate the impact of health-related quality of life on depressive symptoms in elderly patients undergoing TAVI, and 2. to analyze beliefs about TAVI. Methods: A total of 131 elderly people (mean age: 82.1 ± 6.1 years) scheduled to receive TAVI completed the Geriatric Depression Scale, EQ-5D-3L, and Mini Mental State Examination. A total of 43 patients completed the questionnaires after the treatment. The narrative interview analyses were performed based on 20 randomly selected patients after TAVI. Results: The mean level of general depression before TAVI was 4.19 ± 2.83, and after it was 3.12 ± 2.52 (p = 0.02), and the frequency decreased from 20% to 3%. An increase in the level of activity and number of interests and a decrease in life satisfaction were identified. The higher the general quality of life was, the lower the levels of depressiveness before and after TAVI were (r = 0.26 vs. r = 0.48; p < 0.05). Conclusions: Patients differed in their depressive symptoms, as well as their intensity and frequency, before and after TAVI. These results underscore the importance of screening for depression at baseline and reassessing changes in depressiveness during follow-up.
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Affiliation(s)
- Katarzyna Olszewska-Turek
- Medical Psychology Department, Chair of Psychiatry, Jagiellonian University Medical College, 31-501 Kraków, Poland
- Department of Clinical Psychology, University Hospital, 30-688 Kraków, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Correspondence: ; Tel.: +48-12-400-12-36
| | - Barbara Bętkowska-Korpała
- Medical Psychology Department, Chair of Psychiatry, Jagiellonian University Medical College, 31-501 Kraków, Poland
- Department of Clinical Psychology, University Hospital, 30-688 Kraków, Poland
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Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:68-74. [PMID: 33868420 PMCID: PMC8039915 DOI: 10.5114/aic.2021.104771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access. Aim To assess early- and mid-term clinical outcomes after TA-TAVI. Material and methods Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed. Results Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0-84.0) years; 55.7% were males. Median baseline EuroSCORE I and STS scores were 18.2% (11.6-27.7) and 4.8% (3.3-8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15-8.76: p = 0.026; RR for AVA per 0.1 cm2 1.28, 95% CI: 1.03-1.55: p = 0.024; RR for GFR per 1 ml/min 0.96: 95% CI: 0.94-0.99: p = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01-1.17: p = 0.033; RR for RVSP per 1 mm Hg 1.07: 95% CI 1.02-1.16: p = 0.011). Conclusions Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes.
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