The impact of frailty and surgical risk on quality of life after TAVI: A systematic review and meta-analysis.

Autor: van der Velden, Kim, Spaetgens, Bart, Buhre, Wolfgang, Maesen, Bart, Boer, Dianne De Korte-de, van Kuijk, Sander, van 't Hof, Arnoud, Schreiber, Jan
Zdroj: Journal of Cardiothoracic & Vascular Anesthesia; Dec2024:Supplement, Vol. 38 Issue 12, p78-79, 2p
Abstrakt: Symptomatic aortic stenosis and frailty reduce quality of life (QoL). Transcatheter aortic valve implantation (TAVI) in patients at high-extreme risk has proven it's beneficial effect on QoL. Currently, TAVI is also considered in patients at intermediate risk. Our meta-analysis investigates whether QoL benefit after TAVI is more pronounced in frail patients and patients at high-extreme vs. intermediate surgical risk. A systematic search of the literature was performed in November 2021 and updated in November 2023 in PUBMED, EMBASE, and the Cochrane Controlled Trials Register for randomized controlled trials (RCTs) and observational studies. Statistical analysis was performed according to the inverse variance method and the random effects model. Heterogeneity was calculated using I2 statistics. Results A total of 951 studies were assessed of which 19 studies were included (17 cohort studies and 2 RCTs). Meta-analysis showed a mean increase of Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 26.8 points [20.2, 33.4] in the general TAVI population (p <.00001). In addition, subanalyses showed a KCCQ increase of 29.6 points [26.0, 33.1] in high-extreme risk patients versus 21.0 [20.9, 21.1] in intermediate risk patients at 1 year after TAVI ((p< 0.00001) (Figure 1). Analysis in frail patients calculated a KCCQ score increase of 24.6 points [21.5, 27.8] (p =.02). This was not statistically significant compared to the general TAVI population with a mean KCCQ score increase of 26.8 points [20.2, 33.4] (p=0.55) (Figure 2). However, qualitative analyses of nonrandomized studies showed opposite results. TAVI improves QoL significantly in the general TAVI population, more so in high-extreme compared to intermediate risk patients. Frailty's impact on QoL post-TAVI are inconclusive, due to varying outcomes in RCT's vs. non-RCTs, preventing a definitive conclusion. [ABSTRACT FROM AUTHOR]
Databáze: Supplemental Index
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