Skip to main content
SpringerLink
Log in

The impact of transcatheter aortic valve implantation on quality of life: results from the German transcatheter aortic valve interventions registry

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objectives

Transcatheter aortic valve implantation (TAVI) has proven a survival benefit in patients with severe symptomatic aortic stenosis (AS). Recently published data from the German TAVI registry reported a 1-year mortality rate of 19.9 %. However, there are limited data for the effect of TAVI on quality of life (QoL), especially in real life settings.

Methods

The German TAVI registry was launched to evaluate safety, effectiveness and QoL of TAVI in daily clinical routine. We analyzed health-related QoL, using the EQ-5D questionnaire.

Results

Quality-of-life data were eligible for 460 patients who survived 12 months after TAVI (82.5 ± 6.0 years; 32.2 % men). At baseline, QoL (EQ-5D-index: 0.63 ± 0.26) was markedly depressed, but significantly improved 30 days and 12 months (0.67 ± 0.24; 0.70 ± 0.24; p < 0.0001) after TAVI procedure. In addition, the visual analogue health scale, recording the patient’s self-rated health, significantly (p < 0.0001) increased from 42.0 ± 15.9 % at baseline to 57.0 ± 17.2 % (30 days) and 57.7 ± 19.6 % (12 months). A lower EQ-5D-index at baseline, a percutaneous transfemoral/transaxillar TAVI procedure, and indications other than frailty for TAVI were determinants for an improved QoL 1 year after TAVI.

Conclusions

Among patients with AS, TAVI resulted in meaningful improvements in QoL. This benefit was present shortly after TAVI and maintained for at least 1 year. Different gains in QoL regarding patient-subgroups and determinants for improved QoL could give further impetus for patient selection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lindroos M, Kupari M, Heikkila J, Tilvis R (1993) Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 2:1220–1225

    Article  Google Scholar 

  2. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 24:1231–1243

    Article  PubMed  Google Scholar 

  3. Aronow WS, Ahn C, Kronzon I, Nanna M (1993) Prognosis of congestive heart failure in patients aged ≥62 years with unoperated severe valvular aortic stenosis. Am J Cardiol 72:846–848

    Article  CAS  PubMed  Google Scholar 

  4. Iung B, Cachier A, Baron G, Messika-Zeitoun D, Delahaye F, Tornos P, Gohlke-Barwolf C, Boersma E, Ravaud P, Vahanian A (2005) Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 26:2714–2720

    Article  PubMed  Google Scholar 

  5. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368:1005–1011

    Article  PubMed  Google Scholar 

  6. Leon MB, Smith CR, Mack M, Miller C, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, Trial Investigators PARTNER (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

    Article  CAS  PubMed  Google Scholar 

  7. Smith CR, Leon MB, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana G, Makkar R, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria J, Herrmann H, Akin JJ, Anderson WN, Wang D, Pocock S, Trial Investigators PARTNER (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

    Article  CAS  PubMed  Google Scholar 

  8. Figulla L, Neumann A, Figulla HR, Kahlert P, Erbel R, Neumann T (2011) Transcatheter aortic valve implantation: evidence on safety and efficacy compared with medical therapy. A systematic review of current literature. Clin Res Cardiol 100:265–276

    Article  CAS  PubMed  Google Scholar 

  9. Vahanian A, Alfieri OR, Al-Attar N, Antunes M, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr F, Nataf P, Piérard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, Von Segesser LK, Walther T, European Association of Cardio-Thoracic Surgery, European Society of Cardiology, European Association of Percutaneous Cardiovascular Interventions (2008) Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 34:1–8

    Article  PubMed  Google Scholar 

  10. Figulla HR, Cremer J, Walther T, Gerckens U, Erbel R, Osterspey A, Zahn R (2009) Positionspapier zur kathetergeführten Aortenklappenintervention. Kardiologe 3:199–206

    Article  Google Scholar 

  11. Mudra H, Sack S, Haude M, Gerckens U, Kuck KH, Hambrecht R, Sievert H, Richardt G, Schächinger V, Naber C, Sechtem U, Zahn R, Brachmann J (2011) Strukturelle und organisatorische Voraussetzungen zur Durchführung des Transkatheter-Aortenklappenersatzes (TAVI). Ein Positionspapier der Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) e. V. Kardiologe 5:366–371

  12. Ussia GP, Barbanti M, Cammalleri V, Scarabelli M, Mulè M, Aruta P, Pistritto AM, Immè S, Capodanno D, Sarkar K, Gulino S, Tamburino C (2011) Quality-of-life in elderly patients one year after transcatheter aortic valve implantation for severe aortic stenosis. EuroIntervention 7:573–579

    Article  PubMed  Google Scholar 

  13. Reynolds MR, Magnuson EA, Lei Y, Leon MB, Smith CR, Svensson LG, Webb JG, Babaliaros VC, Bowers BS, Fearon WF, Herrmann HC, Kapadia S, Kodali SK, Makkar RR, Pichard AD, Cohen DJ, Placement of Aortic Transcatheter Valves (PARTNER) Investigators (2011) Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis. Circulation 124:1964–1972

    Article  PubMed  Google Scholar 

  14. Taramasso M, Latib A, Cioni M, Denti P, Buzzatti N, Godino C, Chieffo A, Alfieri O, Colombo A, Maisano F (2012) Quality of life improvement is maintained up to two years after transcatheter aortic valve implantation in high-risk surgical candidates. EuroIntervention 8:429–436

    Article  PubMed  Google Scholar 

  15. Zahn R, Gerckens U, Grube E, Linke A, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Hauptmann KE, Richardt G, Figulla HR, Senges J (2011) Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 32:198–204

    Article  PubMed  Google Scholar 

  16. Abdel-Wahab M, Zahn R, Horack M, Gerckens U, Schuler G, Sievert H, Naber C, Voehringer M, Schäfer U, Senges J, Richardt G (2012) Transcatheter aortic valve implantation in patients with and without concomitant coronary artery disease: comparison of characteristics and early outcome in the German multicenter TAVI registry. Clin Res Cardiol 101:973–981

    Article  PubMed  Google Scholar 

  17. Zahn R, Gerckens U, Linke A, Sievert H, Kahlert P, Hambrecht R, Sack S, Abdel-Wahab M, Hoffmann E, Schiele R, Schneider S, Senges J (2013) Predictors of One-Year Mortality After Transcatheter Aortic Valve Implantation for Severe Symptomatic Aortic Stenosis. Am J Cardiol 112:272–279

    Article  PubMed  Google Scholar 

  18. Abdel-Wahab M, Zahn R, Gerckens U, Linke A, Sievert H, Schäfer U, Kahlert P, Hambrecht R, Sack S, Hoffmann E, Senges J, Schneider S, Richardt G, German TAVI Registry Investigators (2014) Predictors of 1-year mortality in patients with aortic regurgitation after transcatheter aortic valve implantation: an analysis from the multicentre German TAVI registry. Heart 100:1250–1256

    Article  PubMed  Google Scholar 

  19. Sherif MA, Zahn R, Gerckens U, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Richardt G, Schneider S, Senges J, Brachmann J (2014) Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry. Clin Res Cardiol 103:613–620

    Article  PubMed  Google Scholar 

  20. von der Schulenburg JM, Claes C, Greiner W, Uber A (1998) Die deutsche Version des EuroQol-Fragebogens. J Public Health 6:3–20

    Article  Google Scholar 

  21. Greiner W, Claes C (2007) Der EQ-5D der EuroQol-Gruppe. In: Schoeffski O, von der Schulenburg JM (eds) Gesundheitsökonomische Evaluationen, 3rd edn. Springer, Berlin/Heidelberg, pp 403–414

    Google Scholar 

  22. Greiner W, Claes C, van Busschbach J, Graf von der Schulenburg JM (2005) Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 6:124–130

    Article  CAS  PubMed  Google Scholar 

  23. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB (2012) Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 366:1696–1704

    Article  CAS  PubMed  Google Scholar 

  24. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD, Fischbein M, Szeto WY, Lim S, Greason KL, Teirstein PS, Malaisrie SC, Douglas PS, Hahn RT, Whisenant B, Zajarias A, Wang D, Akin JJ, Anderson WN, Leon MB (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366:1686–1695

    Article  CAS  PubMed  Google Scholar 

  25. Bosmans JM, Kefer J, De Bruyne B, Herijgers P, Dubois C, Legrand V, Verheye S, Rodrigus I (2011) Procedural, 30-day and one year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry. Interact CardioVasc Thorac Surg 12:762–767

    Article  PubMed  Google Scholar 

  26. Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Himbert D, Tchetche D, Carrié D, Albat B, Cribier A, Rioufol G, Sudre A, Blanchard D, Collet F, Dos Santos P, Meneveau N, Tirouvanziam A, Caussin C, Guyon P, Boschat J, Le Breton H, Collart F, Houel R, Delpine S, Souteyrand G, Favereau X, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Van Belle E, Laskar M (2012) Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 366:1705–1715

    Article  CAS  PubMed  Google Scholar 

  27. Moat NE, Ludman P, de Belder MA, Bridgewater B, Cunningham AD, Young CP, Thomas M, Kovac J, Spyt T, MacCarthy PA, Wendler O, Hildick-Smith D, Davies SW, Trivedi U, Blackman DJ, Levy RD, Brecker SJ, Baumbach A, Daniel T, Gray H, Mullen MJ (2011) Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 58:2130–2138

    Article  PubMed  Google Scholar 

  28. Ussia GP, Barbanti M, Petronio AS, Tarantini G, Ettori F, Colombo A, Violini R, Ramondo A, Santoro G, Klugmann S, Bedogni F, Maisano F, Marzocchi A, Poli A, De Carlo M, Napodano M, Fiorina C, De Marco F, Antoniucci D, de Cillis E, Capodanno D, Tamburino C (2012) Transcatheter aortic valve implantation: 3-year outcomes of self-expanding CoreValve prosthesis. Eur Heart J 33:969–976

    Article  PubMed  Google Scholar 

  29. Haussig S, Schuler G, Linke A (2014) Worldwide TAVI registries: what have we learned? Clin Res Cardiol 103:603–612

    Article  PubMed  Google Scholar 

  30. Lazar HL (2010) Transcatheter aortic valves - where do we go from here? N Engl J Med 363:1667–1668

    Article  CAS  PubMed  Google Scholar 

  31. O’Sullivan CJ, Stortecky S, Buellesfeld L, Wenaweser P, Windecker S (2014) Preinterventional screening of the TAVI patient: how to choose the suitable patient and the best procedure. Clin Res Cardiol 103:259–274

    Article  PubMed  Google Scholar 

  32. Lefèvre T, Kappetein AP, Wolner E, Nataf P, Thomas M, Schächinger V, De Bruyne B, Eltchaninoff H, Thielmann M, Himbert D, Romano M, Serruys P, Wimmer-Greinecker G, PARTNER EU Investigator Group (2011) One year follow-up of the multi-centre European PARTNER transcatheter heart valve study. Eur Heart J 32:148–157

    Article  PubMed Central  PubMed  Google Scholar 

  33. Reynolds MR, Magnuson EA, Wang K, Lei Y, Vilain K, Walczak J, Kodali SK, Lasala JM, O’Neill WW, Davidson CJ, Smith CR, Leon MB, Cohen DJ (2012) Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation 125:1102–1109

    Article  PubMed  Google Scholar 

  34. Fairbairn TA, Meads DM, Mather AN, Motwani M, Pavitt S, Plein S, Blackman DJ, Greenwood JP (2012) Serial change in health-related quality of life over 1 year after transcatheter aortic valve implantation: predictors of health outcomes. J Am Coll Cardiol 59:1672–1680

    Article  PubMed  Google Scholar 

  35. Kala P, Tretina M, Poloczek M, Ondrasek J, Malik P, Pokorny P, Parenica J, Spinar J, Jarkovsky J, Littnerova S, Nemec P (2013) Quality of life after transcatheter aortic valve implantation and surgical replacement in high-risk elderly patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 157:75–80

    Article  PubMed  Google Scholar 

  36. Kleczyński P, Bagieński M, Sorysz D, Rzeszutko L, Trębacz J, Tomala M, Sobczyński R, Dziewierz A, Surdacki A, Dudek D (2014) Short- and intermediate-term improvement of patient quality of life after transcatheter aortic valve implantation: a single-centre study. Kardiol Pol 72:612–616

    PubMed  Google Scholar 

  37. Gandjour A, Lauterbach KW (1999) Review of quality-of-life evaluations in patients with angina pectoris. Pharmacoeconomics 16:141–152

    Article  CAS  PubMed  Google Scholar 

  38. Dyer MT, Goldsmith KA, Sharples LS, Buxton MJ (2010) A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 8:13

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The German transcatheter aortic valve interventions registry was supported by an unrestricted grant from the Foundation “Stiftung IHF—Institut für Herzinfarktforschung Ludwigshafen”, Germany. The authors thank all the participants who included patients in the German transcatheter aortic valve interventions registry and therefore make this type of research possible.

Conflict of interest

Ralf Zahn, MD has received research funding from Medtronic, Inc., and Edwards Lifesciences. Philipp Kahlert, MD is a clinical proctor for Edwards Lifesciences. The other authors have no conflicts to report.

Author information

Authors and Affiliations

  1. Clinic of Cardiology, University Hospital Essen, Essen, Germany

    Janine Biermann, Philipp Kahlert, Raimund Erbel & Till Neumann

  2. Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany

    Janine Biermann & Jürgen Wasem

  3. Stiftung IHF, Foundation IHF, Institute of Myocardial Infarction Research, Ludwigshafen, Germany

    Martin Horack, Steffen Schneider, Ralf Zahn & Jochen Senges

  4. Department of Medicine II, Cardiology, University Hospital Bonn, Bonn, Germany

    Georg Nickenig

Authors
  1. Janine Biermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Horack
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Kahlert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steffen Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georg Nickenig
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ralf Zahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jochen Senges
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raimund Erbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jürgen Wasem
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Till Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janine Biermann.

Additional information

On behalf of the German Transcatheter Aortic Valve Interventions Registry Investigators.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Biermann, J., Horack, M., Kahlert, P. et al. The impact of transcatheter aortic valve implantation on quality of life: results from the German transcatheter aortic valve interventions registry. Clin Res Cardiol 104, 877–886 (2015). https://doi.org/10.1007/s00392-015-0857-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-015-0857-9

Keywords

Search

Navigation