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Quality of Life Shift after Aortic Valve Replacement in the Era of TAVI: Single-Center Class Comparison Study Between Different Procedural Techniques.

BACKGROUND AND AIM OF THE STUDY
The health-related quality of life (QOL) is one of the most important outcome indicators for elderly people undergoing aortic valve interventions, and should be assessed across different interventions, including emerging percutaneous techniques. The study aim was to assess the change in QOL after different procedures for aortic valve replacement (AVR).


METHODS
QOL was assessed using the Short Form-36 questionnaire (SF-36) for 59 patients after conventional AVR; of these patients, 28 had AVR via a J-sternotomy, a transapical approach was used in 20 patients, and a transfemoral approach in 34.


RESULTS
The early mortality during hospitalization was not significantly different among all four groups. The inverse probability weighted propensity scores adjusted Kaplan-Meier curve revealed that the transapical group had the lowest survival rate. The treatment effect analysis was most prominent in the transfemoral transcatheter aortic valve implantation (TAVI) group across all domains for QOL. The multivariate hierarchical linear mixed final fitted model shows that the transapical TAVI procedure and NYHA class (III-IV) had a significant negative effect on the physical domain and overall QOL score.


CONCLUSION
Changes in QOL after interventions on the aortic valve were determined by the patient's preoperative status and the surgical intervention. The transcatheter intervention, even in 'sicker' patients, provided a gain in QOL comparable with that after an open-heart procedure. Transfemoral TAVI was shown to have advantages over transapical TAVI in terms of QOL improvement at three months and six months, and should be considered the first choice for patients in the high-risk surgical group.