Transfemoral transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are associated with comparable improvements in quality of life (QOL) among intermediate-risk patients after five years, according to new findings published in JACC: Cardiovascular Interventions.[1] Initial outcomes were superior after TAVR, but the two treatment strategies were much closer in impact by the end of the first year.
“Clinical trials have established that TAVR and SAVR result in similar survival at five years among symptomatic patients with aortic stenosis (AS) who are at high or intermediate risk for SAVR, and at 4 years among those at low surgical risk,” wrote first author Neal S. Kleiman, MD, an interventional cardiologist with Houston Methodist DeBakey Heart and Vascular Center, and colleagues. “In parallel, improvement in QOL is similar between the two modalities among patients at high surgical risk through five years and among patients at intermediate surgical risk through two years. However, given factors such as frailty, frequent comorbidities, and other issues not directly related to the valve replacement modality, long-term improvements in health status may be blunted in high-risk patients with AS treated with TAVR or SAVR. Because these factors may play lesser roles in patients at lower surgical risk, the adverse consequences associated with each treatment modality (eg, residual pain, perivalvular leak, pacemaker requirement), and perioperative features may be proportionally more influential in determining patients’ long-term health status.”
To learn more, Kleiman et al. reviewed QOL data from more than 1,500 patients. All data came from the SURTAVI clinical trial, which was sponsored by Medtronic and designed to compare SAVR and TAVR among intermediate-risk patients who presented with symptomatic severe AS. A majority of TAVR patients received a first-generation CoreValve device from Medtronic. The group’s primary tool for monitoring QOL was Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) scores.
“The KCCQ-OS has been used in several previous trials comparing TAVR and SAVR and has been correlated with mortality and rehospitalization rates in the heart failure population,” the authors explained.
Overall, 864 patients were treated with TAVR, and 796 were treated with SAVR. Patients were excluded if TAVR did not include transfemoral access, or if KCCQ-OS data were unavailable. Baseline characteristics between the TAVR and SAVR groups did not reveal any significant differences. For both groups, the mean age was approximately 80 years old, 55-59% of patients were men and the mean Society of Thoracic Surgeons risk score was 4.4.
For TAVR patients, the mean change in KCCQ-OS score was 19 points after 30 days, 21.9 points after six months, 20.5 points after one year and 15.4 points after five years.
For SAVR patients, meanwhile, the mean change in KCCQ-OS score was 5.9 points after 30 days, 21.3 points after six months, 20.5 points after one year and 14.3 points after five years.
One key takeaway from these statistics is the fact that TAVR made a more dramatic change on QOL at first, but the two treatment methods ended up being quite similar after five years. It is also worth noting that the mean change in KCCQ-OS was exactly the same—20.5 points—one full year after treatment.
Another important detail: KCCQ scores specifically focused on physical limitations suggest this is one area where the benefits of TAVR and SAVR may fade over time.
“Although patients undergoing TAVR reported more rapid improvement in symptoms, there were no significant differences in either continuous or categorical measures of health status between the two cohorts by six months,” the authors wrote. “Furthermore, no differences between the groups were observed through five years, suggesting equal and similarly durable health status improvement with either modality in surviving patients, albeit with some attrition in measures of physical limitations.”
The group also looked ahead, saying future studies are needed to “elucidate the mechanisms for the small decline in health status noted at five years compared with one year in both groups.”
Click here to read the full study in JACC: Cardiovascular Interventions, an American College of Cardiology journal.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.