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. 2023 Jan 1;50(1):e217659.
doi: 10.14503/THIJ-21-7659.

Transcatheter Aortic Valve Replacement for Severe Aortic Valve Stenosis: Do Patients Experience Better Quality of Life Regardless of Gradient?

Anthony Simone  1   2 , Juka S Kim  1 , Jeanne Huchting  1 , Asim Rafique  1 , Ruhsen Ozcaglayan  1 , Richard J Shemin  3 , Olcay Aksoy  1 , Murray H Kwon  3
Affiliations

Transcatheter Aortic Valve Replacement for Severe Aortic Valve Stenosis: Do Patients Experience Better Quality of Life Regardless of Gradient?

Anthony Simone et al. Tex Heart Inst J. .

Abstract

Background: Aortic valve replacement improves survival for patients with low-gradient aortic valve stenosis, but there is a paucity of data on postoperative quality of life for this population.

Methods: In a single-center retrospective analysis of 304 patients with severe aortic valve stenosis who underwent transcatheter aortic valve replacement, patients were divided into 4 groups based on mean pressure gradient, left ventricular ejection fraction, and stroke volume index. Using the Kansas City Cardiomyopathy Questionnaire-12, quality of life was assessed immediately before and 1 month after transcatheter aortic valve replacement.

Results: Most patients in the low-flow, low-gradient group were men; this group had higher relative rates of cardiovascular disease and type 2 diabetes than the paradoxical low-flow, low-gradient group; the normal-flow, low-gradient group; and the high-gradient group. All-cause mortality did not differ significantly among the groups at 1 month after surgery, and all groups experienced a significant improvement in quality-of-life scores after surgery. The mean improvement was 27 points in the low-flow, low-gradient group, 25 points in the paradoxical low-flow, low-gradient group, 30 points in the normal-flow, low-gradient group, and 30 points in the high-gradient group (all P < .001).

Conclusion: Quality of life improves significantly across all subgroups of aortic valve stenosis after trans-catheter aortic valve replacement, regardless of flow characteristics or aortic valve gradients.

Keywords: Aortic valve stenosis; quality of life; surveys and questionnaires; transcatheter aortic valve replacement.

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Conflict of interest statement

Conflict of Interest Disclosure: Dr Murray H. Kwon and Dr Richard J. Shemin are paid consultants of Edwards Lifesciences.

Figures

Fig. 1
Fig. 1
All 4 subgroups of severe AS show a dramatic shift in NYHA class distribution 1 month after TAVR, with very few patients falling into class III or IV after valve replacement. Statistical comparisons use the McNemar-Bowker test, with P < .05 considered statistically significant. AS, aortic valve stenosis; HG-AS, high-gradient aortic valve stenosis; LFLG-AS, low-flow, low-gradient aortic valve stenosis; NFLG-AS, normal-flow, low-gradient aortic valve stenosis; NYHA, New York Heart Association; pLFLG-AS, paradoxical low-flow, low-gradient aortic valve stenosis; TAVR, transcatheter aortic valve replacement.
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