[Cognitive and quality of life trajectory after either surgical or transcatheter aortic valve replacement in high-risk patients].
The impact of transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (AVR) on cognitive status and quality of life in high-risk patients has been incompletely investigated.



We conducted a prospective, multicenter study including all patients treated with TAVI and high-risk patients undergoing AVR (age ≥80 years or logistic EuroSCORE ≥15%) at participating centers. Multidimensional geriatric evaluation including Mini Mental State Examination (MMSE), EuroQol 5D (EQ5D) and Minnesota Living With Heart Failure Questionnaire (MLHFQ) were performed at baseline and at 3- and 12-month follow-up.



A total of 518 patients (151 AVR and 367 TAVI) were enrolled in 10 Italian institutions. Patients receiving AVR were older (82.7 ± 2.4 years), with a lower logistic EuroSCORE (12.5 ± 7.1%) as compared with TAVI patients (81.5 ± 6.2 years and 19.6 ± 14.0%, respectively, p=0.001 and p<0.001). Overall, 35.5% of patients showed some degree of cognitive impairment at baseline, with no differences between groups. No significant changes in the cognitive status were observed between baseline and follow-up and between groups at any time point. TAVI patients had a lower quality of life at baseline as compared with AVR patients. Generic and heart failure-related quality of life improved significantly after either procedure.



In high-risk patients, both TAVI and AVR are associated with a significant improvement of quality of life up to 1 year without a detrimental effect on cognitive function.
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Cristina
C
Ciuca
Agenzia Sociale e Sanitaria Regionale, Regione Emilia-Romagna, Bologna.
Daniela
D
Fortuna
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna - Dipartimento di Psicologia, Università degli Studi, Bologna.
Susy
S
Ferrari
U.O. Cardiochirurgia, Città della Salute e della Scienza - Molinette, Torino.
Stefano
S
Salizzoni
SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza - Molinette, Torino.
Enrica
E
Grisoglio
S.C. Cardiochirurgia, Ospedale Mauriziano Umberto I, Torino.
Giuseppe
G
Punta
S.C. Cardiochirurgia, Ospedale Mauriziano Umberto I, Torino.
Stefano
S
Del Ponte
U.O. Cardiologia, Ospedale Mauriziano Umberto I, Torino.
Tiziana Claudia
TC
Aranzulla
U.O. Cardiochirurgia, Hesperia Hospital, Modena.
Davide
D
Gabbieri
U.O. Cardiologia, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo.
Caterina
C
Gandolfo
U.O. Cardiologia, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo.
Flavia
F
Dispensa
U.O. Cardiologia, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo.
Lavinia
L
Vecchio Verderame
U.O. Cardiologia, Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Ospedale Ferrarotto, Catania.
Corrado
C
Tamburino
U.O. Cardiologia, Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Ospedale Ferrarotto, Catania.
Cinzia
C
Caruso
U.O. Cardiochirurgia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo.
Claudio
C
Grossi
Villa Maria Cecilia Hospital, Cotignola (RA).
Elisa
E
Mikus
U.O. Cardiologia Interventistica, Ospedale S. Maria Nuova, Reggio Emilia.
Vincenzo
V
Guiducci
U.O. Cardiologia, A.O. San Camillo-Forlanini, Roma.
Roberto
R
Violini
U.O. Cardiologia, A.O. San Camillo-Forlanini, Roma.
Silvia
S
Rongoni
U.O. Cardiologia, A.O. San Camillo-Forlanini, Roma.
Claudia
C
Pandolfi
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Carolina
C
Moretti
Agenzia Sociale e Sanitaria Regionale, Regione Emilia-Romagna, Bologna.
Rossana
R
De Palma
Dipartimento di Psicologia, Università degli Studi, Bologna.
Rabih
R
Chattat
U.O. Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Carlo
C
Savini
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Antonio
A
Marzocchi
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Francesco
F
Saia
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003071:Cognition; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000523:psychology; D006801:Humans; D007558:Italy; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement / Q000523:psychology*