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. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

Grimaldi, A., Figini, F., Maisano, F., Montorfano, M., Chieffo, A., Latib, A., et al. (2013). Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis. INTERNATIONAL JOURNAL OF CARDIOLOGY, 168(1), 281-286 [10.1016/j.ijcard.2012.09.079].

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

Grimaldi A.;Cammalleri V.;
2013-01-01

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. (c) 2012 Elsevier Ireland Ltd. All rights reserved.
2013
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE
English
Aortic stenosis; Quality of life; TAVI; Aged, 80 and over; Aortic Valve Stenosis; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Survival Rate; Treatment Outcome; Ultrasonography; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Quality of Life
Grimaldi, A., Figini, F., Maisano, F., Montorfano, M., Chieffo, A., Latib, A., et al. (2013). Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis. INTERNATIONAL JOURNAL OF CARDIOLOGY, 168(1), 281-286 [10.1016/j.ijcard.2012.09.079].
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
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/228593
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