Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
EuroIntervention. 2015 Jun;11(2):221-9. doi: 10.4244/EIJV11I2A41.
To evaluate the effects of access route upon clinical results and quality of life (QoL) in patients undergoing either transfemoral (TF-TAVI) or transapical balloon-expandable transcatheter aortic valve implantation (TA-TAVI) in the real world.
A prospective analysis was performed upon 264 consecutive patients receiving TF-TAVI or TA-TAVI. QoL was assessed using the EQ-5D questionnaire. At baseline, TA-TAVI patients reported significantly more problems in mobility, self-care, usual activities and lower overall health status domains (p<0.01 for all). At 30 days, the TF-TAVI group reported fewer problems with usual activity (p=0.01) and pain/discomfort (p<0.01), and higher EQ-5D index and visual analogue scale (VAS) (p=0.01 and p<0.01, respectively) than the TA-TAVI group. Nevertheless, the absolute improvements (ΔEQ-5D index and ΔEQ-5D VAS) were larger in the TA-TAVI group, with most dramatically marked QoL absolute improvements (p<0.01 and p=0.02, respectively). By one year, notwithstanding higher all-cause mortality in the sicker TA-TAVI group, there were no differences between groups in any EQ-5D domain. Indeed, surviving TA-TAVI group's greater absolute improvements remained (p<0.01).
QoL is greater at the earlier time point of 30 days in the TF-TAVI cohort but equatable by one year. However, the magnitude of improvement in QoL is greater in the TA-TAVI patients at both 30 days and one year.
评估经股动脉（TF-TAVI）或经心尖球囊扩张经导管主动脉瓣植入术（TA-TAVI）入路对真实世界中接受 TF-TAVI 或 TA-TAVI 的患者的临床结果和生活质量（QoL）的影响。
对 264 例连续接受 TF-TAVI 或 TA-TAVI 的患者进行了前瞻性分析。使用 EQ-5D 问卷评估 QoL。在基线时，TA-TAVI 患者在移动性、自理能力、日常活动和整体健康状况方面报告的问题明显更多（所有 P<0.01）。在 30 天时，TF-TAVI 组报告在日常活动（P=0.01）和疼痛/不适（P<0.01）方面的问题较少，EQ-5D 指数和视觉模拟量表（VAS）评分较高（P=0.01 和 P<0.01，分别）比 TA-TAVI 组。然而，TA-TAVI 组的绝对改善（ΔEQ-5D 指数和 ΔEQ-5D VAS）更大，QoL 的绝对改善最显著（P<0.01 和 P=0.02，分别）。在一年时，尽管 TA-TAVI 组患者的全因死亡率更高，但两组在任何 EQ-5D 领域均无差异。实际上，幸存的 TA-TAVI 组的更大的绝对改善仍然存在（P<0.01）。
TF-TAVI 队列在 30 天时的 QoL 更高，但在一年时可达到相同水平。然而，TA-TAVI 患者在 30 天和一年时的 QoL 改善幅度更大。
