Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013 Nov;9(4):281-94.
doi: 10.2174/1573403x09666131202121750.

Beyond adding years to life: health-related quality-of-life and functional outcomes in patients with severe aortic valve stenosis at high surgical risk undergoing transcatheter aortic valve replacement

Marcus-Andre Deutsch, Sabine Bleiziffer, Yacine Elhmidi, Nicolo Piazza, Bernhard Voss, Ruediger Lange, Markus Krane  1
Affiliations
Review

Beyond adding years to life: health-related quality-of-life and functional outcomes in patients with severe aortic valve stenosis at high surgical risk undergoing transcatheter aortic valve replacement

Marcus-Andre Deutsch et al. Curr Cardiol Rev. 2013 Nov.

Abstract

Aortic valve stenosis (AVS) is the most frequent acquired valvular heart disease in western industrialized countries and its prevalence considerably increases with age. Once becoming symptomatic severe AVS has a very poor prognosis. Progressive and rapid symptom deterioration leads to an impairment of functional status and compromised healthrelated quality-of-life (HrQoL) simultaneously. Until recently, surgical aortic valve replacement (SAVR) has been the only effective treatment option for improving symptoms and prolonging survival. Transcatheter aortic valve replacement (TAVR) emerged as an alternative treatment modality for those patients with severe symptomatic AVS in whom the risk for SAVR is considered prohibitive or too high. TAVR has gained clinical acceptance with almost startling rapidity and has even quickly become the standard of care for the treatment of appropriately selected individuals with inoperable AVS during recent years. Typically, patients currently referred for and treated by TAVR are elderly with a concomitant variable spectrum of multiple comorbidities, disabilities and limited life expectancy. Beyond mortality and morbidity, the assessment of HrQoL is of paramount importance not only to guide patient-centered clinical decision-making but also to judge this new treatment modality. As per current evidence, TAVR significantly improves HrQoL in high-surgical risk patients with severe AVS with sustained effects up to two years when compared with optimal medical care and demonstrates comparable benefits relative to SAVR. Along with a provision of a detailed overview of the current literature regarding functional and HrQoL outcomes in patients undergoing TAVR, this review article addresses specific considerations of the HrQoL aspect in the elderly patient and finally outlines the implications of HrQoL outcomes for medico-economic deliberations.

PubMed Disclaimer

Figures

Fig. (1)
Fig. (1)
Domains of the SF-36/SF-12 health survey questionnaire.
Fig. (2)
Fig. (2)
Study design of the US PARTNER randomized controlled trial.
Fig. (3)
Fig. (3)
Overview of SF-36 PCS and MCS for prospective studies evaluating HrQoL up to 1 and 2 years, respectively.
Fig. (4)
Fig. (4)
SF-12 PCS and MCS scores from the US PARTNER trial.
See this image and copyright information in PMC

References

    1. Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373:956–66. - PubMed
    1. Leon MB, Smith CR, Mack M , et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607. - PubMed
    1. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS. 2006 Writing Committee Members, American College of Cardiology/American Heart Association Task Force.2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) endorsed by the Society of Cardiovascular Anesthesiologists. Society for Cardiovascular Angiography and Interventions and Society of Thoracic Surgeons. Circulation. 2008;118:e523–661. - PubMed
    1. Vahanian A, Alfieri O , et al. Authors/Task Force Members. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). . Eur Heart J. 2012 - PubMed
    1. Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108.687 patients in 10 years: changes in risks valve types and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009;137:82–90. - PubMed

LinkOut - more resources