title: Change in quality of life after transcatheter aortic valve implantation and aortic valve replacement surgery in Australian patients aged ≥ 75 years: the effects of EuroSCORE and patient operability.
abstract: OBJECTIVE
  To determine the extent to which differences in generic quality of life (QOL) between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) patients explained by EuroSCORE and heart-team operability assessment.
  
  
  METHODS
  A total of 146 high-risk patients with EuroSCORE > 6 and aged ≥ 75 years underwent TAVI (n = 80) or aortic valve replacement (n = 66) between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EuroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration.
  
  
  RESULTS
  The AVR group required longer ventilation (> 24 h) (TAVI 5.0% vs. AVR 20.6%, P = 0.004) and more units of red blood cells [TAVI 0 (0-1) vs. AVR 2 (0-3), P = 0.01]. New renal failure was higher in TAVI (TAVI 5.0% vs. AVR 0%, P = 0.06). TAVI patients reported significantly lower vitality (P = 0.01) by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% (general health) - 62.9% (physical role)] whereas deterioration in QOL occurred less frequently [range 9.3% (physical role) - 33.3% (mental health)].
  
  
  CONCLUSIONS
  Clinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.
authors: Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Bedford Park 5042, Australia ; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, University of Adelaide, North Terrace, Adelaide 5005, Australia.
authors: Phillip J
authors: PJ
authors: Tully
authors: Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia.
authors: Prakash
authors: P
authors: Roshan
authors: Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia.
authors: Greg D
authors: GD
authors: Rice
authors: Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia.
authors: Ajay
authors: A
authors: Sinhal
authors: Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Bedford Park 5042, Australia ; Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia.
authors: Jayme S
authors: JS
authors: Bennetts
authors: Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Bedford Park 5042, Australia ; Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia.
authors: Robert A
authors: RA
authors: Baker
keywords: Aortic valve replacement; Cardiac surgery; EuroSCORE; Quality of life; Transcatheter aortic valve implantation