Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis
In patients with severe aortic stenosis (AS) at low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) results in lower rates of death, stroke, and rehospitalization at 1 year compared with surgical aortic valve replacement; however, the effect of treatment strategy on healt...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2019-12, Vol.74 (23), p.2833-2842 |
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| creator | Baron, Suzanne J. Magnuson, Elizabeth A. Lu, Michael Wang, Kaijun Chinnakondepalli, Khaja Mack, Michael Thourani, Vinod H. Kodali, Susheel Makkar, Raj Herrmann, Howard C. Kapadia, Samir Babaliaros, Vasilis Williams, Mathew R. Kereiakes, Dean Zajarias, Alan Alu, Maria C. Webb, John G. Smith, Craig R. Leon, Martin B. Cohen, David J. |
| description | In patients with severe aortic stenosis (AS) at low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) results in lower rates of death, stroke, and rehospitalization at 1 year compared with surgical aortic valve replacement; however, the effect of treatment strategy on health status is unknown.
This study sought to compare health status outcomes of TAVR versus surgery in low-risk patients with severe AS.
Between March 2016 and October 2017, 1,000 low-risk patients with AS were randomized to transfemoral TAVR using a balloon-expandable valve or surgery in the PARTNER 3 (Placement of Aortic Transcatheter Valves) trial. Health status was assessed at baseline and 1, 6, and 12 months using the KCCQ (Kansas City Cardiomyopathy Questionnaire), SF-36 (Short Form-36 Health Survey), and EQ-5D (EuroQoL). The primary endpoint was change in KCCQ-OS (KCCQ Overall Summary) score over time. Longitudinal growth curve modeling was used to compare changes in health status between treatment groups over time.
At 1 month, TAVR was associated with better health status than surgery (mean difference in KCCQ-OS 16.0 points; p |
| doi_str_mv | 10.1016/j.jacc.2019.09.007 |
| format | Article |
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This study sought to compare health status outcomes of TAVR versus surgery in low-risk patients with severe AS.
Between March 2016 and October 2017, 1,000 low-risk patients with AS were randomized to transfemoral TAVR using a balloon-expandable valve or surgery in the PARTNER 3 (Placement of Aortic Transcatheter Valves) trial. Health status was assessed at baseline and 1, 6, and 12 months using the KCCQ (Kansas City Cardiomyopathy Questionnaire), SF-36 (Short Form-36 Health Survey), and EQ-5D (EuroQoL). The primary endpoint was change in KCCQ-OS (KCCQ Overall Summary) score over time. Longitudinal growth curve modeling was used to compare changes in health status between treatment groups over time.
At 1 month, TAVR was associated with better health status than surgery (mean difference in KCCQ-OS 16.0 points; p < 0.001). At 6 and 12 months, health status remained better with TAVR, although the effect was reduced (mean difference in KCCQ-OS 2.6 and 1.8 points respectively; p < 0.04 for both). The proportion of patients with an excellent outcome (alive with KCCQ-OS ≥75 and no significant decline from baseline) was greater with TAVR than surgery at 6 months (90.3% vs. 85.3%; p = 0.03) and 12 months (87.3% vs. 82.8%; p = 0.07).
Among low-risk patients with severe AS, TAVR was associated with meaningful early and late health status benefits compared with surgery.
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2019.09.007</identifier><identifier>PMID: 31577923</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aortic stenosis ; Aortic valve ; Aortic Valve - surgery ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - surgery ; Cardiology ; Cardiomyopathy ; Cardiovascular disease ; Echocardiography ; Female ; Follow-Up Studies ; Health ; Health Status ; Heart Valve Prosthesis ; Humans ; low surgical risk ; Male ; Mortality ; Patients ; Population ; Prospective Studies ; Quality of Life ; Questionnaires ; Risk ; Severity of Illness Index ; Stenosis ; Surgery ; transcatheter aortic valve replacement ; Transcatheter Aortic Valve Replacement - methods ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 2019-12, Vol.74 (23), p.2833-2842</ispartof><rights>2019 American College of Cardiology Foundation</rights><rights>Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>2019. American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-3de1933f793e0f60e78653990018b848798f0f83cd0437332cdae68ed877ca893</citedby><cites>FETCH-LOGICAL-c428t-3de1933f793e0f60e78653990018b848798f0f83cd0437332cdae68ed877ca893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2019.09.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31577923$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baron, Suzanne J.</creatorcontrib><creatorcontrib>Magnuson, Elizabeth A.</creatorcontrib><creatorcontrib>Lu, Michael</creatorcontrib><creatorcontrib>Wang, Kaijun</creatorcontrib><creatorcontrib>Chinnakondepalli, Khaja</creatorcontrib><creatorcontrib>Mack, Michael</creatorcontrib><creatorcontrib>Thourani, Vinod H.</creatorcontrib><creatorcontrib>Kodali, Susheel</creatorcontrib><creatorcontrib>Makkar, Raj</creatorcontrib><creatorcontrib>Herrmann, Howard C.</creatorcontrib><creatorcontrib>Kapadia, Samir</creatorcontrib><creatorcontrib>Babaliaros, Vasilis</creatorcontrib><creatorcontrib>Williams, Mathew R.</creatorcontrib><creatorcontrib>Kereiakes, Dean</creatorcontrib><creatorcontrib>Zajarias, Alan</creatorcontrib><creatorcontrib>Alu, Maria C.</creatorcontrib><creatorcontrib>Webb, John G.</creatorcontrib><creatorcontrib>Smith, Craig R.</creatorcontrib><creatorcontrib>Leon, Martin B.</creatorcontrib><creatorcontrib>Cohen, David J.</creatorcontrib><creatorcontrib>PARTNER 3 Investigators</creatorcontrib><title>Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>In patients with severe aortic stenosis (AS) at low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) results in lower rates of death, stroke, and rehospitalization at 1 year compared with surgical aortic valve replacement; however, the effect of treatment strategy on health status is unknown.
This study sought to compare health status outcomes of TAVR versus surgery in low-risk patients with severe AS.
Between March 2016 and October 2017, 1,000 low-risk patients with AS were randomized to transfemoral TAVR using a balloon-expandable valve or surgery in the PARTNER 3 (Placement of Aortic Transcatheter Valves) trial. Health status was assessed at baseline and 1, 6, and 12 months using the KCCQ (Kansas City Cardiomyopathy Questionnaire), SF-36 (Short Form-36 Health Survey), and EQ-5D (EuroQoL). The primary endpoint was change in KCCQ-OS (KCCQ Overall Summary) score over time. Longitudinal growth curve modeling was used to compare changes in health status between treatment groups over time.
At 1 month, TAVR was associated with better health status than surgery (mean difference in KCCQ-OS 16.0 points; p < 0.001). At 6 and 12 months, health status remained better with TAVR, although the effect was reduced (mean difference in KCCQ-OS 2.6 and 1.8 points respectively; p < 0.04 for both). The proportion of patients with an excellent outcome (alive with KCCQ-OS ≥75 and no significant decline from baseline) was greater with TAVR than surgery at 6 months (90.3% vs. 85.3%; p = 0.03) and 12 months (87.3% vs. 82.8%; p = 0.07).
Among low-risk patients with severe AS, TAVR was associated with meaningful early and late health status benefits compared with surgery.
[Display omitted]</description><subject>Aged</subject><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiology</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular disease</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health</subject><subject>Health Status</subject><subject>Heart Valve Prosthesis</subject><subject>Humans</subject><subject>low surgical risk</subject><subject>Male</subject><subject>Mortality</subject><subject>Patients</subject><subject>Population</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Questionnaires</subject><subject>Risk</subject><subject>Severity of Illness Index</subject><subject>Stenosis</subject><subject>Surgery</subject><subject>transcatheter aortic valve replacement</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFrGzEQhUVJaBy3f6CHIMill3VGq92VBL2Y0CQFQ0LsukehaGcbbde7jqRNyb-vjN0ccggMDCN98xjeI-QLgxkDVl20s9ZYO8uBqRmkAvGBTFhZyoyXShyRCQheZgyUOCGnIbQAUEmmPpITzkohVM4nJN6g6eIjXUYTx0DnTURPV970wZr4iLtpjT6kr-XofztrOjoffHSWrk33jPQet52xuME-UtfTxfA3u3fhD70z0aW3QH-5pH5YWUbsh-DCJ3LcmC7g50Ofkp9X31eXN9ni9vrH5XyR2SKXMeM1MsV5IxRHaCpAIauSKwXA5IMspFCygUZyW0PBBee5rQ1WEmsphDVS8Sn5utfd-uFpxBD1xgWLXWd6HMagcw6QnCoYJPT8DdoOo-_TdYnKQbEcCpmofE9ZP4TgsdFb7zbGv2gGepeJbvUuE73LREOqFMGUnB2kx4cN1q8r_0NIwLc9gMmLZ4deB5vMs1g7jzbqenDv6f8DWPucfA</recordid><startdate>20191210</startdate><enddate>20191210</enddate><creator>Baron, Suzanne J.</creator><creator>Magnuson, Elizabeth A.</creator><creator>Lu, Michael</creator><creator>Wang, Kaijun</creator><creator>Chinnakondepalli, Khaja</creator><creator>Mack, Michael</creator><creator>Thourani, Vinod H.</creator><creator>Kodali, Susheel</creator><creator>Makkar, Raj</creator><creator>Herrmann, Howard C.</creator><creator>Kapadia, Samir</creator><creator>Babaliaros, Vasilis</creator><creator>Williams, Mathew R.</creator><creator>Kereiakes, Dean</creator><creator>Zajarias, Alan</creator><creator>Alu, Maria C.</creator><creator>Webb, John G.</creator><creator>Smith, Craig R.</creator><creator>Leon, Martin B.</creator><creator>Cohen, David J.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20191210</creationdate><title>Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis</title><author>Baron, Suzanne J. ; Magnuson, Elizabeth A. ; Lu, Michael ; Wang, Kaijun ; Chinnakondepalli, Khaja ; Mack, Michael ; Thourani, Vinod H. ; Kodali, Susheel ; Makkar, Raj ; Herrmann, Howard C. ; Kapadia, Samir ; Babaliaros, Vasilis ; Williams, Mathew R. ; Kereiakes, Dean ; Zajarias, Alan ; Alu, Maria C. ; Webb, John G. ; Smith, Craig R. ; Leon, Martin B. ; Cohen, David J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-3de1933f793e0f60e78653990018b848798f0f83cd0437332cdae68ed877ca893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aortic stenosis</topic><topic>Aortic valve</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiology</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular disease</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health</topic><topic>Health Status</topic><topic>Heart Valve Prosthesis</topic><topic>Humans</topic><topic>low surgical risk</topic><topic>Male</topic><topic>Mortality</topic><topic>Patients</topic><topic>Population</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Questionnaires</topic><topic>Risk</topic><topic>Severity of Illness Index</topic><topic>Stenosis</topic><topic>Surgery</topic><topic>transcatheter aortic valve replacement</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baron, Suzanne J.</creatorcontrib><creatorcontrib>Magnuson, Elizabeth A.</creatorcontrib><creatorcontrib>Lu, Michael</creatorcontrib><creatorcontrib>Wang, Kaijun</creatorcontrib><creatorcontrib>Chinnakondepalli, Khaja</creatorcontrib><creatorcontrib>Mack, Michael</creatorcontrib><creatorcontrib>Thourani, Vinod H.</creatorcontrib><creatorcontrib>Kodali, Susheel</creatorcontrib><creatorcontrib>Makkar, Raj</creatorcontrib><creatorcontrib>Herrmann, Howard C.</creatorcontrib><creatorcontrib>Kapadia, Samir</creatorcontrib><creatorcontrib>Babaliaros, Vasilis</creatorcontrib><creatorcontrib>Williams, Mathew R.</creatorcontrib><creatorcontrib>Kereiakes, Dean</creatorcontrib><creatorcontrib>Zajarias, Alan</creatorcontrib><creatorcontrib>Alu, Maria C.</creatorcontrib><creatorcontrib>Webb, John G.</creatorcontrib><creatorcontrib>Smith, Craig R.</creatorcontrib><creatorcontrib>Leon, Martin B.</creatorcontrib><creatorcontrib>Cohen, David J.</creatorcontrib><creatorcontrib>PARTNER 3 Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baron, Suzanne J.</au><au>Magnuson, Elizabeth A.</au><au>Lu, Michael</au><au>Wang, Kaijun</au><au>Chinnakondepalli, Khaja</au><au>Mack, Michael</au><au>Thourani, Vinod H.</au><au>Kodali, Susheel</au><au>Makkar, Raj</au><au>Herrmann, Howard C.</au><au>Kapadia, Samir</au><au>Babaliaros, Vasilis</au><au>Williams, Mathew R.</au><au>Kereiakes, Dean</au><au>Zajarias, Alan</au><au>Alu, Maria C.</au><au>Webb, John G.</au><au>Smith, Craig R.</au><au>Leon, Martin B.</au><au>Cohen, David J.</au><aucorp>PARTNER 3 Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2019-12-10</date><risdate>2019</risdate><volume>74</volume><issue>23</issue><spage>2833</spage><epage>2842</epage><pages>2833-2842</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>In patients with severe aortic stenosis (AS) at low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) results in lower rates of death, stroke, and rehospitalization at 1 year compared with surgical aortic valve replacement; however, the effect of treatment strategy on health status is unknown.
This study sought to compare health status outcomes of TAVR versus surgery in low-risk patients with severe AS.
Between March 2016 and October 2017, 1,000 low-risk patients with AS were randomized to transfemoral TAVR using a balloon-expandable valve or surgery in the PARTNER 3 (Placement of Aortic Transcatheter Valves) trial. Health status was assessed at baseline and 1, 6, and 12 months using the KCCQ (Kansas City Cardiomyopathy Questionnaire), SF-36 (Short Form-36 Health Survey), and EQ-5D (EuroQoL). The primary endpoint was change in KCCQ-OS (KCCQ Overall Summary) score over time. Longitudinal growth curve modeling was used to compare changes in health status between treatment groups over time.
At 1 month, TAVR was associated with better health status than surgery (mean difference in KCCQ-OS 16.0 points; p < 0.001). At 6 and 12 months, health status remained better with TAVR, although the effect was reduced (mean difference in KCCQ-OS 2.6 and 1.8 points respectively; p < 0.04 for both). The proportion of patients with an excellent outcome (alive with KCCQ-OS ≥75 and no significant decline from baseline) was greater with TAVR than surgery at 6 months (90.3% vs. 85.3%; p = 0.03) and 12 months (87.3% vs. 82.8%; p = 0.07).
Among low-risk patients with severe AS, TAVR was associated with meaningful early and late health status benefits compared with surgery.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31577923</pmid><doi>10.1016/j.jacc.2019.09.007</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2019-12, Vol.74 (23), p.2833-2842 |
| issn | 0735-1097 1558-3597 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Aortic stenosis Aortic valve Aortic Valve - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - surgery Cardiology Cardiomyopathy Cardiovascular disease Echocardiography Female Follow-Up Studies Health Health Status Heart Valve Prosthesis Humans low surgical risk Male Mortality Patients Population Prospective Studies Quality of Life Questionnaires Risk Severity of Illness Index Stenosis Surgery transcatheter aortic valve replacement Transcatheter Aortic Valve Replacement - methods Treatment Outcome |
| title | Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis |
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