Quality-of-Life Outcomes After Transcatheter Aortic Valve Replacement in an Unselected Population

Abstract

Although the pivotal trials^1-7 demonstrated survival and quality-of-life (QOL) benefits of transcatheter aortic valve replacement (TAVR) within select cohorts of patients and hospital centers, understanding how this novel technology performs as it moves beyond experienced centers and operators and outside of the strict inclusion and exclusion criteria of the clinical trials is of critical importance. To understand these outcomes more fully, the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC) developed the STS/ACC Transcatheter Valve Therapy (TVT) Registry.⁸ In the TVT Registry, unselected patients treated with TAVR from January 1, 2011, to December 31, 2013, experienced a 1-year survival rate of 76%,⁹ similar to that observed in the pivotal trials. In this elderly population with extensive comorbidity and impaired health status, however, prolonged survival alone (without improved health status) is unlikely to be viewed as a desirable outcome. The importance of improving and maintaining health status after TAVR in these patients has been recognized not only by patients and physicians but also by the Centers for Medicare & Medicaid Services, which requires the collection and monitoring of health status outcomes as part of the national registry. To better understand the full range of benefits of TAVR in clinical practice, we examined the short- and long-term health status outcomes of surviving patients after TAVR in the TVT Registry.