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OBJECTIVE:
Transcatheter aortic valve implantation (TAVI) is a standard approach for severe aortic stenosis in high risk surgical candidates. Transaortic route (TAo) is gaining popularity as an approach for TAVI. The aim of this study was to assess the impact on the quality of life (QoL), pain control, functional status and mid term survival after this procedure.
METHODS:
Twenty-five consecutive patients (84.5 ± 6.4. years, 21 men and 15 women) with a logistic Euroscore of 29.7 ± 13.7 underwent TAVI using the Edwards Sapien Valve (Edwards Lifescience, Irvine, CA, USA). Aortic valve was implanted via Transapical route in 19 patients via mini-thoracotomy. Six patients had direct TAo implantation via hemisternotomy. Post operative pain was analysed with Numeric Rating scale (NRS-11). QoL was evaluated by administering the Short Form 36 (SF-36) tool and the shorter SF-12 version 2 (SF-12v2) questionnaires before and 1-year after TAVI.
RESULTS: TAVI was successfully performed in all patients. The estimated 1-year survival was 72%. Mean follow up was 14 ± 8 months. There was significant improvement in echocardiographic parameters (peak gradient 54.2 ± 26.1 vs 18.4 ± 7.8 mm Hg, P< .001; aortic valve area 0.8 ± 0.1 vs 2.4 ± 1.7 cm2, P < .001) with a significant change in New York Heart Association class (4 ± 0.7 vs 1.2 ± 0.4, P < .001).
There was a significant improvement in physical and mental scores on SF-12v12 and SF-36. There was no difference in quality of life improvement in the transaortic vs. transapical groups respectively, SF-36 (56.2 vs.54.5, P=0.78) at 1 year. Results for physical component summary (PCS, SF-12v12) was similar in tansaortic vs. transapical group (44.1 vs. 45.2 p=0.53) . There was no difference in (MCS) mental quality summary (38.2 vs.39.4, p=0.51). Mean pain score was higher in the tansapical group on day 1,(7.4 vs. 4.1, p=0.02), but was similar on day 4(3.2 vs. 3.8, p=0.50). There was no difference in analgesia requirements.
CONCLUSIONS: There was physical and mental improvement in quality of life in transortic and transapical group of patients, patients in transapical group experienced more pain in the immediate post procedural period.