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You are here: Contents > 2017 > Volume 26 Number 5 September 2017 > AORTIC VALVE DISEASE > Association of Change in Patient-Reported Health Status after Transcatheter Aortic Valve Replacement, and Postoperative Outcomes

Association of Change in Patient-Reported Health Status after Transcatheter Aortic Valve Replacement, and Postoperative Outcomes

Alexis Kofi Okoh1,3,4, Nathan Kang1, Dhaval Chauhan1, Nicky Haik1, Dustin Hanos3, Marc Cohen2, Chungeng Chen2, Bruce Haik1, Mark J. Russo1

1Department of 1Cardiothoracic Surgery, R.W.J. Barnabas Health-Newark Beth Israel Medical Center, Newark, New Jersey, USA
2Department of Cardiology, R.W.J. Barnabas Health-Newark Beth Israel Medical Center, Newark, New Jersey, USA
3Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
4Electronic correspondence: disciple951@gmail.com

Background and aim of the study: The study aim was to investigate the relationship between postoperative morbidity after transcatheter aortic valve replacement (TAVR) and short-term patient-reported health status, using the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Methods: The association between 30-day post-procedure changes in patient-reported heath status and post-TAVR outcomes was examined. Patients were stratified into three groups based on observed changes in KCCQ-Overall scores (OS): Group A, increase in KCCQ-OS ≥10 points; Group B, KCCQ-OS scores <10 points; and Group C, decline in KCCQ-OS ≥10 points. Variation components of KCCQ scores were determined using paired t-tests. Postoperative morbidity was investigated. Multivariable logistic regression was used to identify pre-procedural factors associated with an increase or decline in KCCQ-OS at 30 days.

Results: A total of 223 patients with complete baseline and

postoperative 30-day KCCQ responses was studied. At the 30-day follow up there was a significant change in baseline mean KCCQ-OS for all patients (mean difference 14.1; p <0.0001). Improvement in KCCQ-OS ≥10 was observed in 130 patients (58%), 64 patients (29%) had no change, and 29 patients (13%) had a decline in KCCQ-OS ≥10. The incidence of acute kidney injury (AKI), permanent pacemaker (PPM) placement and new-onset arrhythmia (NOA) was higher in group C than in groups A and B: AKI, 11%, 0%, 0%; p <0.001; PPM, 21%, 4%, 6%; p = 0.004; and NOA, 21%, 5%, 8%, p = 0.026. Independent predictors of decline in KCCQ scores after TAVR were PPM requirement (estimate: 0.76 CI 0.22, 1.29; p = 0.005) and NYHA functional class (III/IV) (estimate: -0.41 CI -0.71, 0.10; p = 0.009). Conclusion: TAVR patients experienced an improvement in health status after the procedure, but for a smaller proportion their health status worsened. Patients who experience perioperative complications may have a decline in their health status after the procedure in the short term.

The Journal of Heart Valve Disease 2017;26:493-501
Association of Change in Patient-Reported Health Status after Transcatheter Aortic Valve Replacement, and Postoperative Outcomes

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