Relationship of Hemodynamic Improvement and Quality of Life Outcomes After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is a rapidly expanding option for patients with severe aortic stenosis. TAVR has been shown to improve both survival and quality of life. However, the relationship between post-TAVR echocardiographic gradient and quality of life has not been well studied or compared in self-expanding (SEVs) and balloon expandable (BEVs) valves.

To explore correspondence of post-TAVR echocardiographic gradients and quality of life outcomes.

In a multicenter retrospective registry of patients undergoing TAVR the relationship between discharge mean gradient (MG) on transthoracic echocardiography (TTE) and quality-of-life scores using Kansas City Cardiomyopathy Questionnaire (KCCQ) was examined at 1 month and 1 year.

During the study period, complete data for 1 month KCCQ and discharge MG data was available in 1093 patients from two high volume institutions. These included 410 (37%) SEVs and 683 (63%) BEVs. At discharge, after adjusting for baseline variables, MG was lower with SEV compared to BEV (8.5 ± 4.7 mmHg vs. 10.6 ± 4.9 mmHg, p < 0.001), however change in KCCQ score was similar for both (31.1 ± 21.8 [SEV] vs. 31.7 ± 22.9 [BEVs], p = 0.68). In the combined cohort, discharge MG was not associated with improvement in 1-month or 1-year KCCQ and did not predict change in 1-month or 1-year NYHA class. Patients with higher NYHA classifications exhibited smaller changes in KCCQ scores from baseline at 30 days. (p < 0.001).

In this study of TAVR patients, echocardiogram-derived MG at discharge was not associated with quality-of-life improvement as determined by change in KCCQ or NYHA class at 1 month or 1 year.