title: Quality of life in high-risk patients: comparison of transcatheter aortic valve implantation with surgical aortic valve replacement.
abstract: OBJECTIVE
  To compare health-related quality of life (QoL) in patients undergoing transcatheter aortic valve implantation via transapical access (TA TAVI) with patients undergoing surgical aortic valve replacement (SAVR).
  
  
  METHODS
  One hundred and forty-four high-risk patients referred for aortic valve replacement underwent TAVI screening and were assigned to either TA TAVI (n = 51, age 79.7 ± 9.2 years, logistic EuroSCORE 26.5 ± 16.1%, 51% males) or SAVR (n = 93, age 81.1 ± 5.3 years, logistic EuroSCORE 12.1 ± 9.3%, 42% males) by the interdisciplinary heart team. QoL was assessed using the Short Form 36 (SF-36) Health Survey Questionnaire and the Hospital Anxiety and Depression Scale. Furthermore, current living conditions and the degree of independence at home were evaluated.
  
  
  RESULTS
  Patients undergoing TA TAVI were at higher risk as assessed by EuroSCORE (26.5 ± 16 vs. 12.1 ± 9, P < 0.001) and STS score (6.7 ± 4 vs. 4.4 ± 3, P < 0.001) compared with SAVR patients. At the 30-day follow-up, the rate of mortality was similar and amounted to 7.8% for TA TAVI and 7.5% for SAVR patients and raised to 25.5% in TA TAVI and 18.3% in SAVR patients after a follow-up period of 15 ± 10 months. Assessment of QoL revealed no differences in terms of anxiety and depression between TA TAVI and SAVR patients. The SF-36 mental health metascore was similar in both groups (65.6 ± 19 vs. 68.8 ± 22, P = 0.29), while a significant difference was observed in the physical health metascore (49.7 ± 21 vs. 62.0 ± 21, P = 0.015). After adjustment for baseline characteristics, this difference disappeared. However, every added point in the preoperative risk assessment with the STS score decreased the SF-36 physical health dimension by two raw points at the follow-up assessment.
  
  
  CONCLUSIONS
  Selected high-risk patients undergoing TAVI by using a transapical access achieve similar clinical outcomes and QoL compared with patients undergoing SAVR. Increased STS scores predict worse QoL outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Centre,  University Hospital of Bern, Bern,  Switzerland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Amonn
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Henriette
authors.initials: H
authors.lastname: Brinks
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000523:psychology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D016009:Chi-Square Distribution; D003863:Depression / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010359:Patient Readmission; D011788:Quality of Life; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome