Quality of Life After Transcatheter Aortic Valve Replacement in Normal-Flow, Low-Gradient Aortic Stenosis

Ibrahim Khaleel; Andrew W Harris; Milan Seth; Devraj Sukul; G Michael Deeb; Megan S Joseph; P Michael Grossman; Shinichi Fukuhara; Stanley Chetcuti

doi:10.1016/j.jacadv.2023.100641

Quality of Life After Transcatheter Aortic Valve Replacement in Normal-Flow, Low-Gradient Aortic Stenosis

JACC Adv. 2023 Oct 5;2(9):100641. doi: 10.1016/j.jacadv.2023.100641. eCollection 2023 Nov.

Authors

Ibrahim Khaleel¹, Andrew W Harris², Milan Seth³, Devraj Sukul², G Michael Deeb⁴, Megan S Joseph², P Michael Grossman², Shinichi Fukuhara⁴, Stanley Chetcuti²

Affiliations

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
² Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
³ BMC2 Cardiovascular Consortium, Ann Arbor, Michigan, USA.
⁴ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

Background: Prior studies of aortic valve replacement (AVR) in patients with normal-flow, low-gradient aortic stenosis (NF-LG AS) have demonstrated conflicting results regarding the survival benefit of AVR. Changes in quality of life (QoL) after transcatheter AVR (TAVR) have not been reported in this population.

Objectives: The purpose of this study was to compare changes in QoL after TAVR for patients with NF-LG AS to patients with high-gradient aortic stenosis (HG-AS).

Methods: Patients who underwent TAVR for severe aortic stenosis (AS) were divided into 4 hemodynamic profiles of AS, including NF-LG AS. Changes in Kansas City Cardiomyopathy Questionnaire-12 score from baseline to 1 year were compared between AS groups. The primary composite outcome indicating clinical improvement consisted of survival to 1 year and improved Kansas City Cardiomyopathy Questionnaire overall summary score of ≥5 points while adjusting for relevant baseline factors.

Results: Out of 860 patients who underwent TAVR, high gradient AS was present in 368 (42.8%) patients and NF-LG AS in 245 (28.5%). HG-AS and NF-LG AS groups had a similar proportion of patients who met the primary unadjusted outcome of clinical improvement (70.4% vs 63.9%, respectively; P = 0.189). One-year Kaplan-Meier mortality estimates were higher for NF-LG AS patients than HG-AS patients (12.9% vs 5.8%, P < 0.001). In the primary adjusted analysis, there was no significant difference in the composite outcome between HG and NF-LG AS groups (adjusted OR: 0.72, 95% CI: 0.47-1.11).

Conclusions: Selected patients with NF-LG AS experienced similar improvement in QoL after TAVR compared with HG-AS. Further investigation of patients with NF-LG AS will help to inform optimal selection for treatment with TAVR.

Keywords: health-related quality of life (QoL); low gradient aortic stenosis; normal-flow; transcatheter aortic valve replacement (TAVR).