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Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation.

ABSTRACT: BACKGROUND:Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI. METHODS:The TAVI Care & Cure Program is an ongoing, prospective, observational study including patients referred for TAVI to our institution. A comprehensive geriatric assessment was performed to evaluate existence of frailty using the Erasmus Frailty Score (EFS). HRQoL was assessed using the EQ-5D-5 L at baseline and 1 year after TAVI. RESULTS:239 patients underwent TAVI and completed HRQoL assessment 1 year after TAVI. Seventy (29.3%) patients were classified as frail (EFS???3). In non-frail patients, the EQ-5D-5 L index did not change (0.71(± 0.22) to 0.68(± 0.33) points, P =?0.22); in frail patients, the EQ-5D-5 L index decreased from 0.55(±0.26) to 0.44 points (±0.33) (P =?0.022). Frailty was an independent predictor of deteriorated HRQoL 1 year after TAVI (OR 2.24, 95% CI 1.07-4.70, P =?0.003). In frail patients, the absence of peripheral artery disease (OR 0.17, 95% 0.05-0.50, P =?0.001) and renal dysfunction (OR 0.13, 95% CI 0.04-0.41, P =?<0.001) at baseline was associated with improved HRQoL 1 year after TAVI. CONCLUSION:Frailty is associated with deterioration of HRQoL 1 year after TAVI. Notably, HRQoL did improve in frail patients with no peripheral arterial disease or renal impairment at baseline.

SUBMITTER: Goudzwaard JA

PROVIDER: S-EPMC7583518 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation.

Goudzwaard Jeannette A JA de Ronde-Tillmans Marjo J A G MJAG van Hoorn Fleurance E D FED Kwekkeboom Eline H C EHC Lenzen Mattie J MJ van Wiechen Maarten P H MPH Ooms Joris F W JFW Nuis Rutger-Jan RJ Van Mieghem Nicolas M NM Daemen Joost J de Jaegere Peter P T PPT Mattace-Raso Francesco U S FUS

Age and ageing 20201001 6

<h4>Background</h4>Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI.<h4>Methods</h4>The TAVI Care & Cure Program is an ongoing, prospective, observational study including pati ...[more]

PMID: 32421189

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Project description:ObjectiveTranscatheter aortic valve implantation (TAVI) procedures are increasing rapidly, but the durability of tissue valve and periprocedural complications are not satisfactory. Immune reaction to the galactose-α-1,3 galactose β-1,4-N-acetylglucosamine (α-Gal) and conventional processing protocols of cardiac xenografts lead to calcification. Next-generation TAVI needs to be made with α-Gal-free xenografts by multiple anticalcification therapies to avoid immune rejection and enhance durability, and three-dimensional (3D) printing technology to improve the procedural safety.MethodsPorcine pericardia were decellularized and immunologically modified with α-galactosidase. The pericardia were treated by space filler, crosslinked with glutaraldehyde in organic solvent, and detoxified. The sheep-specific nitinol (nickel-titanium memory alloy) wire backbone was made from a 3D-printed model for ovine aortic root. After it passed the fitting test, we manufactured a self-expandable stented valve with the porcine pericardia mounted on the customized nitinol wire-based stent. After in vitro circulation using customized silicone aortic root, we performed TAVI in 9 sheep and obtained hemodynamic, radiological, immunohistopathological, and biochemical results.ResultsThe valve functioned well, with excellent stent fitting and good coronary flow under in vitro circulation. Sheep were sequentially scheduled to be humanely killed until 238 days after TAVI. Echocardiography and cardiac catheterization demonstrated good hemodynamic status and function of the aortic valve. The xenografts were well preserved without α-Gal immune reaction or calcification based on the immunological, radiographic, microscopic, and biochemical examinations.ConclusionsWe proved preclinical safety and efficacy for next-generation α-Gal-free TAVI with multiple anticalcification therapies and 3D-printing technology. A future clinical study is warranted based on these promising preclinical results.

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Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation.

Publications

Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation.

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