Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Quality of Life Measures in Aortic Stenosis Research: A Narrative Review

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.

Health-related quality of life following transcatheter aortic valve implantation using transaortic, transfemoral approaches and surgical aortic valve replacement-a single-center study

Objective

To evaluate short- and long-term changes in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI) and to assess differences in patient QoL when using the TAVI transaortic (TAVI TAo) approach compared with the transfemoral approach (TAVI TF) and surgical aortic valve replacement (SAVR).

Methods

Ninety-seven patients were assessed. Thirty-two patients underwent TAVI TAo, 31 underwent TAVI TF and 34 patients underwent SAVR. QoL was assessed using the EQ-5D-3L questionnaire at baseline, after one month and one year.

Results

Mean patient age was 80 years (range, 61–92 years) and the mean logistic EuroSCORE was 12.45% (range, 1.39%–78.98%). Declared health state at baseline was significantly lower in TAVI TF (P < 0.001) and after one month there were no differences between the three groups (P = 0.99). After one year, SAVR patient results of the EQ-5D-3L index value were lower in comparison to both TAVI patient groups (P < 0.05). The analysis also showed significant differences between the results of EQ-5D-3L index value over the one month and one year follow-up (TAVI TAo, P < 0.001; TAVI TF, P < 0.05; SAVR, P < 0.05). In all groups, the values significantly increased after one-month and one-year of follow-up in comparison to baseline value. Significant differences were also demonstrated between Visual Analogue Scale values (VAS).

Conclusions

A significant improvement in QoL was observed in all three patient groups. Regardless of the TAVI approach, EQ-5D-3L and VAS values were significantly increased after one-month and one-year follow up; the SAVR patients however, reported lower health status when compared to the TAVI patients.