Cardiovascular Institute, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
Int J Cardiol. 2013 Jan 10;162(2):117-22. doi: 10.1016/j.ijcard.2011.05.050. Epub 2011 Jun 1.
Transcatheter aortic valve implantation (TAVI) techniques have been presenting good procedural success and favorable clinical outcomes. However, optimal management of aortic valve disease in elderly patients depends on quality of life (QoL) improvement. In this study we aimed to evaluate changes in QoL in patients referred for TAVI.
Prospective analysis of 74 consecutive patients (34 male), aged 81.6 ± 8 years with symptomatic severe aortic valve stenosis (AS) ineligible for conventional aortic valve replacement, referred to TAVI in one tertiary center. For the assessment of QoL, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used before the procedure and at 6.5 months. The mortality was 9.5% at 30 days and 20.2% at 6.5 months follow-up. Fifty three (71.6%) patients completed MLHFQ at baseline and at follow-up. All patients showed good hemodynamic results and no signs of prosthesis dysfunction were observed on transthoracic echocardiography. The New York Heart Association (NYHA) class (2.9 ± 0.4 to 1.4 ± 0.7; p<0.001), and the MLHFQ scores [overall (37.0 ± 14.7 vs. 14.4 ± 10.1; p<0.001), physical dimension (23.2 ± 9.5 vs. 8.6 ± 5.9; p<0.001) and emotional dimension (5.4 ± 4.2 vs. 2.6 ± 3.0; p<0.001)] were significantly improved 6.5 months after TAVI. Patients with peripheral vascular disease (PVD) had an inferior improvement in QoL caused by a lower enhancement in physical dimension MLHFQ score (mean difference: -17.0 ± 10.2 vs. -10.1 ± 11.5; p=0.036).
TAVI significantly improves symptoms and QoL in patients with severe AS and high surgical risk. Patients with PVD might be expected to have a less impressive improvement in QoL after TAVI.
经导管主动脉瓣植入术（TAVI）技术已取得良好的手术成功率和有利的临床结果。然而，老年患者主动脉瓣疾病的最佳治疗取决于生活质量（QoL）的改善。本研究旨在评估 TAVI 患者 QoL 的变化。
前瞻性分析了 74 例连续患者（34 名男性），年龄 81.6±8 岁，患有症状性严重主动脉瓣狭窄（AS），不适合常规主动脉瓣置换，在一家三级中心接受 TAVI。为了评估 QoL，使用明尼苏达州心衰生活质量问卷（MLHFQ）在术前和 6.5 个月时进行评估。30 天死亡率为 9.5%，6.5 个月随访时死亡率为 20.2%。53 例（71.6%）患者在基线和随访时完成了 MLHFQ。所有患者均表现出良好的血液动力学结果，且经胸超声心动图未观察到假体功能障碍的迹象。纽约心脏协会（NYHA）心功能分级（2.9±0.4 至 1.4±0.7；p<0.001）和 MLHFQ 评分[整体（37.0±14.7 至 14.4±10.1；p<0.001），身体维度（23.2±9.5 至 8.6±5.9；p<0.001）和情绪维度（5.4±4.2 至 2.6±3.0；p<0.001）]在 TAVI 后 6.5 个月显著改善。患有外周血管疾病（PVD）的患者 QoL 改善程度较低，这是由于身体维度 MLHFQ 评分的改善程度较低（平均差异：-17.0±10.2 与-10.1±11.5；p=0.036）。
TAVI 可显著改善严重 AS 和高手术风险患者的症状和 QoL。患有 PVD 的患者 TAVI 后 QoL 的改善可能不明显。
