Trajectory of cognitive function and quality of life following stenotic aortic valve procedures

Abstract

Aims: Severe aortic valve stenosis can be treated with either surgical valve replacement (SAVR) or transcatheter valve implantation (TAVI). The choice between these two strategies is guided by the age and clinical profile of the patient. Our study aims to verify the hypothesis that including health-related quality of life (HRQL) as an outcome measure may be relevant to therapeutic choice. Methods: This prospective observational study included 806 patients aged 65–80 years who received either SAVR or TAVI. HRQL was assessed using the SF-12 questionnaire before and after the procedure (1–4 years of follow-up). Propensity score matching was applied to account for baseline differences between groups, resulting in two matched groups of 92 patients each. A subgroup of 80 patients received a neurocognitive function assessment before the procedure and at 2–3 months of follow-up. Results: At 1-year follow-up, no significant differences were observed between SAVR and TAVI in terms of the mental and physical components of the SF-12, with both procedures resulting in significant improvements in HRQL in both the prematching and propensity-matched populations. In the prematching population, at 4-years follow-up and after adjustment for potential confounders, the cumulative risk of HRQL deterioration did not differ significantly between SAVR and TAVI for the mental component (hazards ratio 1.03, 95% confidence interval 0.69–1.56, P = 0.881), while it was significantly higher (hazards ratio 1.89, 95% confidence interval 1.02–3.59, P = 0.045) for the physical component in the TAVI group. After propensity score matching, these results were confirmed, with no significant differences in the mental component (hazards ratio 1.14, 95% confidence interval 0.65–2.00, P = 0.640) and a significantly higher risk of worsening in the physical component in the TAVI group (hazards ratio 3.91, 95% confidence interval 1.46–10.5, P = 0.007). Early cognitive impairment was associated with a significantly higher risk of deterioration in the mental component at 1-year follow-up (relative risk 3.2, 95% confidence interval 1.18–8.94, P = 0.023). Conclusion: In a real-world scenario, no differences in quality of life were observed between SAVR and TAVI at 1-year follow-up; conversely, at 4-year follow-up, the physical component of HRQL appeared to be better preserved in patients undergoing SAVR.