Resultados reportados por pacientes muy mayores tras implante valvular aórtico percutáneo

Martín Leonardo Gil Folgar; María Florencia Grande Ratti; Gastón Perman; Ignacio Miguel Seropian; Cristian Maximiliano Garmendia; Maximiliano Smietniansky; María Eugenia Riggi; Carla Romina Agatiello; María Celeste Puga

doi:10.47487/apcyccv.v7i2.634

Authors

Martín Leonardo Gil Folgar Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano, Argentina. https://orcid.org/0009-0002-4029-2645
María Florencia Grande Ratti Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano, Argentina. https://orcid.org/0000-0001-8622-8230
Gastón Perman Servicio de Clínica Médica y Gerencia Médica del Plan de Salud, Hospital Italiano, Argentina; Universidad Hospital Italiano de Buenos Aires, Argentina. https://orcid.org/0000-0002-5606-8210
Ignacio Miguel Seropian Servicio de Hemodinamia y Cardiología Intervencionista, Hospital Italiano de Buenos Aires, Argentina. https://orcid.org/0000-0002-6823-4001
Cristian Maximiliano Garmendia Servicio de Hemodinamia y Cardiología Intervencionista, Hospital Italiano de Buenos Aires, Argentina. https://orcid.org/0000-0003-1159-7757
Maximiliano Smietniansky Servicio de Clínica Médica y Sección de Medicina Geriátrica, Hospital Italiano, Argentina https://orcid.org/0000-0002-4904-3779
María Eugenia Riggi Sección de Medicina Geriátrica, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Argentina. https://orcid.org/0000-0001-5943-3714
Carla Romina Agatiello Servicio de Hemodinamia y Cardiología Intervencionista, Hospital Italiano de Buenos Aires, Argentina. https://orcid.org/0000-0002-4753-2616
María Celeste Puga Gerencia Médica del Plan de Salud, Hospital Italiano de Buenos Aires, Argentina. https://orcid.org/0000-0002-5479-143X

DOI:

https://doi.org/10.47487/apcyccv.v7i2.634

Keywords:

Transcatheter Aortic Valve Implantation, Aortic Valve Stenosis, Quality of Life, Patient Reported Outcome Measures, Argentina

Abstract

Objectives. To evaluate patient-reported outcomes (PROMs) in patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis by comparing health-related quality of life before the procedure and at 12 months of follow-up in a real-world clinical practice setting. Materials and methods. An observational study was conducted, including 120 consecutive patients treated within an integrated healthcare network who underwent surgery between April 2021 and March 2024. Quality of life was assessed using the EQ-5D-5L questionnaire and the EQVAS visual analog scale. Descriptive analyses and paired comparisons were performed, with p<0.05 considered statistically significant. Results. The mean age was 83 ± 5 years; 62% were women. The EQ-VAS showed a significant increase (65.7 ± 21.8 vs. 74.3 ± 15.2; p=0.003). At baseline, the most affected dimensions were mobility, pain/discomfort, and anxiety/ depression. At follow-up, a significant improvement was observed in anxiety/depression (47.5% vs. 29.2%; p=0.003). No significant changes were observed in the other dimensions. No differences were observed in the EQ-5D-5L. Conclusions. In elderly patients undergoing TAVI, a significant improvement in emotional well-being and global health perception was observed at one year, with functional stability in other dimensions. These findings reinforce the importance of incorporating PROMs into the comprehensive assessment and TAVI indication for older adults.

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References

Trivi M, Castro MF, Trossero R, Cura FA, Piccinini F, Candiello A, et al. Impacto de un Heart Team en pacientes con estenosis aórtica candidatos a reemplazo percutáneo. Rev Argent Cardiol. 2023;91(4):257-62. doi: 10.7775/rac.es.v91.i4.20649.

Ambrosy AP, Go AS, Leong TK, Garcia EA, Chang AJ, Slade JJ, et al. Temporal trends in the prevalence and severity of aortic stenosis within a contemporary and diverse community-based cohort. Int J Cardiol. 2023;384:107-11. doi: 10.1016/j.ijcard.2023.04.047.

Swift SL, Puehler T, Misso K, Lang SH, Forbes C, Kleijnen J, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis. BMJ Open. 2021;11(12):e054222. doi: 10.1136/bmjopen-2021-054222.

Sztejfman M, Sztejfman C, Albertal M, Gómez Márquez R, Goldsmit A, Chiminella FG, et al. Problemas y soluciones en la implementación de un Programa de Implante Valvular Aórtico Percutáneo. Rev Argent Cardiol. 2013;81(1):15-21. doi: 10.7775/ rac.es.v81.i1.2150.

Garmendia C, Seropian I, Chiabrando J, Medina de Chazal H, Cal M, Kotowicz V, et al. Prevalencia, predictores e impacto clínico de la rehospitalización en pacientes con estenosis valvular aórtica valorados por unHeart Team. Rev Argent Cardiol. 2021;89(6):501- 6. doi: 10.7775/rac.es.v89.i6.20459.

Borracci RA. El costo-efectividad del implante transcatéter de la válvula aórtica en Argentina. Rev Argent Cardiol 2020;88(1):76-9. doi: 10.7775/rac.es.88.i1.14686.

Chotnoppharatphatthara P, Yoodee V, Taesotikul S, Yadee J, Permsuwan U. Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis: systematic review of cost-effectiveness analysis. Eur J Health Econ. 2023;24(3):359- 76. doi: 10.1007/s10198-022-01477-3.

Petrou P. The economics of TAVI: A systematic review. Int J Cardiol Heart Vasc. 2023;44:101173. doi: 10.1016/j.ijcha.2023.101173.

Levett JY, Windle SB, Filion KB, Brunetti VC, Eisenberg MJ. Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients. Am J Cardiol. 2020;125(8):1230-8. doi: 10.1016/j.amjcard.2020.01.017.

Weldring T, Smith SMS. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights. 2013;6:61-8. doi: 10.4137/HSI.S11093.

Akmaz B, Zipfel N, Bal RA, Rensing BJWM, Daeter EJ, van der Nat PB. Developing process measures in value-based healthcare: the case of aortic valve disease. BMJ Open Qual. 2019;8(4):e000716. doi: 10.1136/bmjoq-2019-000716.

Thevathasan T, Reitz F, Hornig C, Leistner DM, Dreger H, Sündermann S, et al. Sex Differences in Clinical and PatientReported Outcomes in Transcatheter Aortic Valve Implantation: The TAVI-COMIC Trial. JACC Adv. 2025;4(8):102012. doi: 10.1016/j. jacadv.2025.102012.

Tamm AR, Jobst ML, Geyer M, Hahad O, Buderus V, Schmidt A, et al. Quality of life in patients with transcatheter aortic valve implantation: an analysis from the INTERVENT project. Front Cardiovasc Med. 2023;10:1181771. doi: 10.3389/ fcvm.2023.1181771.

Smietniansky M, Boietti BR, Del Rosario Cal MA, Abellán VA, Fucile GP, Giunta DH, et al. Utilidad de una evaluación geriátrica integral dirigida a la determinación de riesgos para prácticas y procedimiento (DRIPP) en el adulto mayor. Rev Hosp Ital BAires. 2016;36(3):112-8. doi: 10.51987/Rev.Hosp.Ital.B.Aires.v36i3.666.

Romeo FJ, Smietniansky M, Cal M, Garmendia C, Valle Raleigh JM, Seropian IM, et al. Measuring frailty in patients with severe aortic stenosis: a comparison of the Edmonton Frail Scale with modified Fried Frailty Assessment in patients undergoing transcatheter aortic valve replacement. J Geriatr Cardiol. 2020;17(7):441-6. doi: 10.11909/j.issn.1671-5411.2020.07.001.

Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res. 2021;30(3):647-73. doi: 10.1007/s11136-020- 02688-y.

Cheng LJ, Tan RLY, Luo N. Measurement Properties of the EQ VAS Around the Globe: A Systematic Review and Meta-Regression Analysis. Value Health. 2021;24(8):1223-33. doi: 10.1016/j. jval.2021.02.003.

VARC-3 WRITING COMMITTEE:, Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, et al. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021;77(21):2717-46. doi: 10.1016/j. jacc.2021.02.038.

Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, et al. Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years. N Engl J Med. 2023;389(21):1949-60. doi: 10.1056/ NEJMoa2307447.

Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, et al. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv. 2024;17(8):979-8. doi: 10.1016/j.jcin.2024.02.014.

Romeo FJ, Seropian IM, Chiabrando JG, Raleigh JV, Smietniansky M, Cal M, et al. Additive prognostic value of carbohydrate antigen-125 over frailty in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2021;97(2): E263-73. doi: 10.1002/ccd.29067.

Garmendia CM, Seropian IM, Damonte JI, Medina del Chazal H, Kotowicz V, Cal M, et al. Clinical implications of Body Mass Index and sarcopenic obesity in patients with severe aortic stenosis. Minerva Cardiol Angiol. 2025;73(4):471-8. doi: 10.23736/S2724- 5683.24.06577-3.

Garmendia CM, Chiabrando JG, Medina de Chazal H, Seropian IM, Cal M, Falconi M, et al. Impacto clínico de la hipoalbuminemia en pacientes con estenosis aórtica severa sometidos a reemplazo valvular aórtico percutáneo. Rev Arg Cardioangiol Interv. 2022;(03):0118-0122. doi: 10.30567/RACI/202203/0118-0122.

Alarouri HS, El Shaer A, Ponce AC, Mahayni A, Sulaiman S, Samimi S, et al. Prognostic Value of Patient-Reported Outcomes in Predicting Long-Term Mortality After Transcatheter Aortic Valve Replacement. J Am Heart Assoc. 2023;12(19):e030383. doi: 10.1161/JAHA.123.030383.

Ruiz-Beltrán AM, Chacón-Loyola G, Barajas-Campos RL, AlcarazGuzmán A, Montoya-Hernández MA, Alcázar-Flores LD, et al. Performance of scoring systems for predicting mortality after cardiac surgery in the elderly. Arch Peru Cardiol Cir Cardiovasc. 2025;6(1):29-35. doi: 10.47487/apcyccv.v6i1.459.

Anand A, Harley C, Visvanathan A, Shah ASV, Cowell J, MacLullich A, et al. The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2017;3(2):123-32. doi: 10.1093/ehjqcco/qcw030.

Petrovic M, Spirito A, Sartori S, Vogel B, Tchetche D, Petronio AS, et al. Prognostic Impact of Prefrailty and Frailty in Women Undergoing TAVR: Insights From the WIN-TAVI Registry. Can J Cardiol. 2024;40(3):457-67. doi: 10.1016/j.cjca.2023.10.024.

Tomii D, Lanz J, Heg D, Möllmann H, Kim WK, Burgdorf C, et al. The Impact of Frailty on VARC-3 Integrated Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Adv. 2025;4(3):101594. doi: 10.1016/j.jacadv.2025.101594.

Frantzen AT, Eide LSP, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, et al. Frailty Status and Patient-Reported Outcomes in Octogenarians Following Transcatheter or Surgical Aortic Valve Replacement. Heart Lung Circ. 2021;30(8):1221-31. doi: 10.1016/j. hlc.2020.10.024.

Suc G, Boureau AS, Durand E, Benamer H, Cayla G, Béziau D, et al. Poor outcome after transcatheter aortic valve implantation using the EuroQoL-5-dimension-5-level: insights from the FRANCE TAVI registry. Eur Heart J Qual Care Clin Outcomes. 2026;12(1):12-24. doi: 10.1093/ehjqcco/qcaf041.