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Meta-Analysis
. 2023 Nov;23(6):594-605.
doi: 10.7861/clinmed.2023-0258.

Health-related quality of life following TAVI or cardiac surgery in patients at intermediate and low risk: a systematic review and meta-analysis

Ahmed R Gonnah  1 , Mohamed Abdelwahab  2 , Rebecca Taylor  3 , Aser Labib  4 , Omar Masoud  5 , Maciej Debski  6 , Hesham Kamal Abdelaziz  7 , David Hesketh Roberts  8
Affiliations
Meta-Analysis

Health-related quality of life following TAVI or cardiac surgery in patients at intermediate and low risk: a systematic review and meta-analysis

Ahmed R Gonnah et al. Clin Med (Lond). 2023 Nov.

Abstract

Recent randomised trials have shown that clinical outcomes with transcatheter aortic valve implantation (TAVI) are non-inferior to surgical aortic valve replacement (SAVR) in patients with symptomatic aortic stenosis at intermediate to low risk. Health-related quality of life (HrQoL) outcomes in these patient groups remain uncertain. A systematic search of the literature was conducted that included nine trials and 11,295 patients. Kansas City Cardiomyopathy Questionnaire (KCCQ), a heart-failure-specific measure and EuroQol-5D (EQ-5D) (a generic health status tool) changes were the primary outcomes. New York Heart Association (NYHA) classification was the secondary outcome. Improvement in KCCQ scores was greater with TAVI (mean difference (MD)=13.56, 95% confidence interval (CI) 11.67-15.46, p<0.001) at 1 month, as was the improvement in EQ-5D (MD=0.07, 95% CI 0.05-0.08, p<0.001). There was no difference in KCCQ (MD=1.05, 95% CI -0.11 to 2.21, p=0.08) or EQ-5D (MD=-0.01, 95% CI -0.03 to 0.01), p=0.37) at 12 months. NYHA functional class 3/4 was lower in patients undergoing TAVI at 1 month (MD=0.51, 95% CI 0.34-0.78, p=0.002), but there was no difference at 12 months (MD=1.10; 95% CI 0.87-1.38, p=0.43). Overall, TAVI offers early benefit in HRQoL outcomes compared with SAVR, but they are equivalent at 12 months.

Keywords: EQ-5D; KCCQ; NYHA; SAVR; TAVI; aortic stenosis.

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Figures

Fig 1
Fig 1
Current treatment approach for patients with severe aortic stenosis. SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve intervention.
Fig 2
Fig 2
Difference in Kansas City Cardiomyopathy Questionnaire (KCCQ) overall scores after 1 and 12 months as reported in six studies. CI = confidence interval; MD = mean difference; SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve intervention.
Fig 3
Fig 3
Difference in EuroQol-5D (EQ-5D) utility scores after 1 and 12 months as reported by two studies. CI = confidence interval; MD = mean difference; SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve intervention.
Fig 5
Fig 5
Pooled proportions of New York Heart Association (NYHA) class 3 and 4 at baseline, 1 and 12 months. Data points are the proportion of patients in NYHA class 3/4 out of total patients in each cohort (TAVI vs SAVR) across all studies at each time point. SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve intervention.
Fig 6
Fig 6
Risk of NYHA class 3 or 4 at baseline, 1 and 12 months. CI = confidence interval; RR = relative risk; SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve intervention.
Fig 4
Fig 4
Number of patients in New York Heart Association (NYHA) classes aggregated across all studies at each time point (six studies at baseline and 12 months, four studies at 1 month). SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve intervention.
Fig 7
Fig 7
Risk of bias assessment utilising Cochrane RoB 2.0.
See this image and copyright information in PMC

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