Author + information
- Received September 12, 2016
- Accepted September 22, 2016
- Published online December 19, 2016.
- Rüdiger Lange, MD, PhDa,b,∗ (, )
- Andreas Beckmann, MDc,
- Till Neumann, MDd,
- Markus Krane, MDa,b,
- Marcus-André Deutsch, MDa,
- Sandra Landwehr, PhDe,
- Joachim Kötting, DiplState,
- Armin Welz, MDf,
- Ralf Zahn, MDg,
- Jochen Cremer, MDh,
- Hans R. Figulla, MDi,
- Gerhard Schuler, MDj,
- David M. Holzhey, MDj,
- Anne-Kathrin Funkat, PhDj,
- Gerd Heusch, MD, PhDk,
- Stefan Sack, MDl,
- Miralem Pasic, MDm,
- Thomas Meinertz, MDn,
- Thomas Walther, MDo,
- Karl-Heinz Kuck, MDp,
- Friedhelm Beyersdorf, MDq,
- Michael Böhm, MDr,
- Helge Möllmann, MDs,
- Christian W. Hamm, MDs,
- Friedrich W. Mohr, MDj,
- GARY Executive Board
- aDepartment of Cardiovascular Surgery, German Heart Center, Technische Universität München (TUM), Munich, Germany
- bDZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- cDeutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie [DGTHG], Berlin, Germany
- dDepartment of Cardiology, West German Heart Center Essen, Essen, Germany
- eBQS-Institute, Düsseldorf, Germany
- fDepartment of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
- gDepartment of Cardiology, Heart Center Ludwigshafen, Ludwigshafen, Germany
- hDepartment of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- iDepartment of Internal Medicine I, University Heart Center Jena, Jena, Germany
- jLeipzig Heart Center, University of Leipzig, Leipzig, Germany
- kInstitute of Pathophysiology, University of Essen Medical School, West German Heart and Vascular Center Essen, Germany
- lDepartment of Cardiology, Klinikum Muenchen Schwabing, Munich, Germany
- mDepartment of Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
- nUniversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- oDepartment of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- pDepartment of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- qDepartment of Cardiac Surgery, Heart Center Freiburg University, Freiburg, Germany
- rKlinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- sDepartment of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
- ↵∗Reprint requests and correspondence:
Dr. Rüdiger Lange, Department of Cardiovascular Surgery, German Heart Center, Technische Universität München (TUM), DZHK (German Center for Cardiovascular Research)–partner site Munich Heart Alliance, Lazarettstraße 36, Munich 80636, Germany.
Objectives This study sought to analyze health-related quality-of-life (HrQoL) outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) based on data from GARY (German Aortic Valve Registry).
Background Typically, patients currently referred for and treated by TAVR are elderly with a concomitant variable spectrum of multiple comorbidities, disabilities, and limited life expectancy. Beyond mortality and morbidity, the assessment of HrQoL is of paramount importance not only to guide patient-centered clinical decision-making but also to judge this new treatment modality in this high-risk patient population.
Methods In 2011, 3,875 patients undergoing TAVR were included in the GARY registry. HrQoL was prospectively measured using the EuroQol 5 dimensions questionnaire self-complete version on paper at baseline and 1 year.
Results Complete follow-up EuroQol 5 dimensions questionnaire evaluation was available for 2,288 patients (transvascular transcatheter aortic valve replacement [TAVR-TV]: n = 1,626 and transapical TAVR [TAVR-TA]: n = 662). In-hospital mortality was 5.9% (n = 229) and the 1-year mortality was 23% (n = 893). The baseline visual analog scale score for general health status was 52.6% for TAVR-TV and 55.8% for TAVR-TA and, in parallel to an improvement in New York Heart Association functional class, improved to 59.6% and 58.5% at 1 year, respectively (p < 0.001). Between baseline and 1 year, the number of patients reporting no complaints increased by 7.8% (TAVR-TV) and by 3.5% within the mobility dimension, and by 14.1% (TAVR-TV) and 9.2% within the usual activity dimension, whereas only moderate changes were found for the self-care, pain or discomfort, and anxiety or depression dimensions. In a multiple linear regression analysis several pre- and post-operative factors were predictive for less pronounced HrQoL benefits.
Conclusions TAVR treatment led to improvements in HrQoL, especially in terms of mobility and usual activities. The magnitude of improvements was higher in the TAVR-TV group as compared to the TAVR-TA group. However, there was a sizable group of patients who did not derive any HrQoL benefits. Several independent pre- and post-operative factors were identified being predictive for less pronounced HrQoL benefits.
- German Aortic Valve Registry
- health-related quality-of-life
- transcatheter aortic valve replacement
Dr. Lange has served on the advisory board for Medtronic. Dr. Figulla is a cofounder of, has served as a consultant for, and owns shares in JenaValve; has served a consultant for Abiomed, Occluted, and P and F; and owns shares in Occluted. Dr. Holzhey is proctor for Symetis and Medtronic; and advisor for Edwards Lifesciences. Dr. Hamm has served on the advisory board for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 12, 2016.
- Accepted September 22, 2016.
- American College of Cardiology Foundation