Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis

Antonio Grimaldi, Filippo Figini, Francesco Maisano, Matteo Montorfano, Alaide Chieffo, Azeem Latib, Federico Pappalardo, Pietro Spagnolo, Micaela Cioni, Anna Chiara Vermi, Santo Ferrarello, Daniela Piraino, Valeria Cammalleri, Enrico Ammirati, Francesco Maria Sacco, Iryna Arendar, Egidio Collu, Giovanni La Canna, Ottavio Alfieri, Antonio Colombo

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18 Citations (Scopus)

Abstract

Objective: TAVI is the alternative option in pts with AS deemed ineligible for surgery. Although mortality and morbidity are measures to assess the effectiveness of treatments, quality of life (QOL) should be an additional target. We assessed clinical outcome and QOL in octogenarians following TAVI. Design: All octogenarians with a risk profile considered by the Heart Team to be unacceptable for surgery entered in this registry. QOL was assessed by questionnaires concerning physical and psychic performance. Patients: A hundred forty-five octogenarians (age: 84.7 ± 3.4 years; male: 48.3%) underwent TAVI for AS (97.2%) or isolated AR (2.8%). NYHA class: 2.8 ± 0.6; Logistic EuroScore: 26.1 ± 16.7; STS score: 9.2 ± 7.7.Echocardiographic assessments included AVA (0.77 ± 0.21 cm2), mean/peak gradients (54.5 ± 12.2/88 ± 19.5 mmHg), LVEF (21% = EF ≤ 40%), sPAP (43.1 ± 11.6 mmHg). Interventions: All pts underwent successful TAVI using Edward-SAPIEN valve (71.2%) or Medtronic CoreValve (28.8%). Main outcome measures: Rates of mortality at 30 days, 6 months and 1 year were 2.8%, 11.2% and 17.5%. Results: At 16-month follow up, 85.5% survived showing improved NYHA class (2.8 ± 0.6 vs 1.5 ± 0.7; p <0.001), decreased sPAP (43.1 ± 11.6 mmHg vs 37.1 ± 7.7 mmHg; p <0.001) and increased LVEF in those with EF ≤ 40% (34.9 ± 6% vs 43.5 ± 14.4%; p = 0.006). Concerning QOL, 49% walked unassisted, 79% (39.5% among pts ≥ 85 years) reported self-awareness improvement; QOL was reported as "good" in 58% (31.4% among pts ≥ 85 years), "acceptable according to age" in 34% (16% among pts ≥ 85 years) and "bad" in 8%. Conclusion: TAVI procedures improve clinical outcome and subjective health-related QOL in very elderly patients with symptomatic AS.

Original languageEnglish
Pages (from-to)281-286
Number of pages6
JournalInternational Journal of Cardiology
Volume168
Issue number1
DOIs
Publication statusPublished - Sep 20 2013

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Aortic Valve Stenosis
Quality of Life
Diagnostic Self Evaluation
Mortality
Registries
Transcatheter Aortic Valve Replacement
Outcome Assessment (Health Care)
Morbidity

Keywords

  • Aortic stenosis
  • Quality of life
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis. / Grimaldi, Antonio; Figini, Filippo; Maisano, Francesco; Montorfano, Matteo; Chieffo, Alaide; Latib, Azeem; Pappalardo, Federico; Spagnolo, Pietro; Cioni, Micaela; Vermi, Anna Chiara; Ferrarello, Santo; Piraino, Daniela; Cammalleri, Valeria; Ammirati, Enrico; Sacco, Francesco Maria; Arendar, Iryna; Collu, Egidio; La Canna, Giovanni; Alfieri, Ottavio; Colombo, Antonio.

In: International Journal of Cardiology, Vol. 168, No. 1, 20.09.2013, p. 281-286.

Research output: Contribution to journalArticle

Grimaldi, A, Figini, F, Maisano, F, Montorfano, M, Chieffo, A, Latib, A, Pappalardo, F, Spagnolo, P, Cioni, M, Vermi, AC, Ferrarello, S, Piraino, D, Cammalleri, V, Ammirati, E, Sacco, FM, Arendar, I, Collu, E, La Canna, G, Alfieri, O & Colombo, A 2013, 'Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis', International Journal of Cardiology, vol. 168, no. 1, pp. 281-286. https://doi.org/10.1016/j.ijcard.2012.09.079
Grimaldi, Antonio ; Figini, Filippo ; Maisano, Francesco ; Montorfano, Matteo ; Chieffo, Alaide ; Latib, Azeem ; Pappalardo, Federico ; Spagnolo, Pietro ; Cioni, Micaela ; Vermi, Anna Chiara ; Ferrarello, Santo ; Piraino, Daniela ; Cammalleri, Valeria ; Ammirati, Enrico ; Sacco, Francesco Maria ; Arendar, Iryna ; Collu, Egidio ; La Canna, Giovanni ; Alfieri, Ottavio ; Colombo, Antonio. / Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis. In: International Journal of Cardiology. 2013 ; Vol. 168, No. 1. pp. 281-286.
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T1 - Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis

AU - Grimaldi, Antonio

AU - Figini, Filippo

AU - Maisano, Francesco

AU - Montorfano, Matteo

AU - Chieffo, Alaide

AU - Latib, Azeem

AU - Pappalardo, Federico

AU - Spagnolo, Pietro

AU - Cioni, Micaela

AU - Vermi, Anna Chiara

AU - Ferrarello, Santo

AU - Piraino, Daniela

AU - Cammalleri, Valeria

AU - Ammirati, Enrico

AU - Sacco, Francesco Maria

AU - Arendar, Iryna

AU - Collu, Egidio

AU - La Canna, Giovanni

AU - Alfieri, Ottavio

AU - Colombo, Antonio

PY - 2013/9/20

Y1 - 2013/9/20

N2 - Objective: TAVI is the alternative option in pts with AS deemed ineligible for surgery. Although mortality and morbidity are measures to assess the effectiveness of treatments, quality of life (QOL) should be an additional target. We assessed clinical outcome and QOL in octogenarians following TAVI. Design: All octogenarians with a risk profile considered by the Heart Team to be unacceptable for surgery entered in this registry. QOL was assessed by questionnaires concerning physical and psychic performance. Patients: A hundred forty-five octogenarians (age: 84.7 ± 3.4 years; male: 48.3%) underwent TAVI for AS (97.2%) or isolated AR (2.8%). NYHA class: 2.8 ± 0.6; Logistic EuroScore: 26.1 ± 16.7; STS score: 9.2 ± 7.7.Echocardiographic assessments included AVA (0.77 ± 0.21 cm2), mean/peak gradients (54.5 ± 12.2/88 ± 19.5 mmHg), LVEF (21% = EF ≤ 40%), sPAP (43.1 ± 11.6 mmHg). Interventions: All pts underwent successful TAVI using Edward-SAPIEN valve (71.2%) or Medtronic CoreValve (28.8%). Main outcome measures: Rates of mortality at 30 days, 6 months and 1 year were 2.8%, 11.2% and 17.5%. Results: At 16-month follow up, 85.5% survived showing improved NYHA class (2.8 ± 0.6 vs 1.5 ± 0.7; p <0.001), decreased sPAP (43.1 ± 11.6 mmHg vs 37.1 ± 7.7 mmHg; p <0.001) and increased LVEF in those with EF ≤ 40% (34.9 ± 6% vs 43.5 ± 14.4%; p = 0.006). Concerning QOL, 49% walked unassisted, 79% (39.5% among pts ≥ 85 years) reported self-awareness improvement; QOL was reported as "good" in 58% (31.4% among pts ≥ 85 years), "acceptable according to age" in 34% (16% among pts ≥ 85 years) and "bad" in 8%. Conclusion: TAVI procedures improve clinical outcome and subjective health-related QOL in very elderly patients with symptomatic AS.

AB - Objective: TAVI is the alternative option in pts with AS deemed ineligible for surgery. Although mortality and morbidity are measures to assess the effectiveness of treatments, quality of life (QOL) should be an additional target. We assessed clinical outcome and QOL in octogenarians following TAVI. Design: All octogenarians with a risk profile considered by the Heart Team to be unacceptable for surgery entered in this registry. QOL was assessed by questionnaires concerning physical and psychic performance. Patients: A hundred forty-five octogenarians (age: 84.7 ± 3.4 years; male: 48.3%) underwent TAVI for AS (97.2%) or isolated AR (2.8%). NYHA class: 2.8 ± 0.6; Logistic EuroScore: 26.1 ± 16.7; STS score: 9.2 ± 7.7.Echocardiographic assessments included AVA (0.77 ± 0.21 cm2), mean/peak gradients (54.5 ± 12.2/88 ± 19.5 mmHg), LVEF (21% = EF ≤ 40%), sPAP (43.1 ± 11.6 mmHg). Interventions: All pts underwent successful TAVI using Edward-SAPIEN valve (71.2%) or Medtronic CoreValve (28.8%). Main outcome measures: Rates of mortality at 30 days, 6 months and 1 year were 2.8%, 11.2% and 17.5%. Results: At 16-month follow up, 85.5% survived showing improved NYHA class (2.8 ± 0.6 vs 1.5 ± 0.7; p <0.001), decreased sPAP (43.1 ± 11.6 mmHg vs 37.1 ± 7.7 mmHg; p <0.001) and increased LVEF in those with EF ≤ 40% (34.9 ± 6% vs 43.5 ± 14.4%; p = 0.006). Concerning QOL, 49% walked unassisted, 79% (39.5% among pts ≥ 85 years) reported self-awareness improvement; QOL was reported as "good" in 58% (31.4% among pts ≥ 85 years), "acceptable according to age" in 34% (16% among pts ≥ 85 years) and "bad" in 8%. Conclusion: TAVI procedures improve clinical outcome and subjective health-related QOL in very elderly patients with symptomatic AS.

KW - Aortic stenosis

KW - Quality of life

KW - TAVI

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