title: Quality of Life After Transcatheter Aortic Valve Replacement: Prospective Data From GARY (German Aortic Valve Registry).
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Technische Universität München (TUM), Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany. Electronic address: lange@dhm.mhn.de.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie [DGTHG], Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Beckmann
authors.affiliation: Department of Cardiology, West German Heart Center Essen, Essen, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Technische Universität München (TUM), Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Krane
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Technische Universität München (TUM), Munich, Germany.
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.affiliation: BQS-Institute, Düsseldorf, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Landwehr
authors.affiliation: BQS-Institute, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Kötting
authors.affiliation: Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.affiliation: Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Department of Internal Medicine I, University Heart Center Jena, Jena, Germany.
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
authors.affiliation: Leipzig Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Leipzig Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: David M
authors.initials: DM
authors.lastname: Holzhey
authors.affiliation: Leipzig Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Funkat
authors.affiliation: Institute of Pathophysiology, University of Essen Medical School, West German Heart and Vascular Center Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: Department of Cardiology, Klinikum Muenchen Schwabing, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.affiliation: Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.affiliation: Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiac Surgery, Heart Center Freiburg University, Freiburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Leipzig Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D051346:Mobility Limitation; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: GARY; German Aortic Valve Registry; health-related quality-of-life; transcatheter aortic valve replacement