| Objective:This study aimed to evaluate the data of either disease-specific or generic health-related quality of life(HRQOL)for pre-and post-transcatheter aortic valve replacement(TAVR)and TAVR versus surgical aortic valve replacement(SAVR).Background:Aortic valve disease is an increasingly risk factor of patients' quality of life(QOL).However,data on the effects of TAVR as well as the comparison between TAVR and SAVR on HRQOL were limited.Methods:Electronic databases were searched for all randomized clinical trials(RCTs)and observational studies evaluating QOL for TAVR up to 12 months.Mean difference(MD)and 95%CIs were calculated using a random-effects model.Results:Seven adjusted randomized controlled trials and twenty-three observational studies involving 41186 patients were included,with a mean age of 82.2±6.8.50.7%of patients were male and high surgical risk with 8.1±5.4%mean Society of Thoracic Surgeons(STS)risk score.After TAVR,patients improved in both disease-specific and generic health status measures,with MD 20.76(95%CI 14.55-26.97,P=0.01,I2=99%),MD 24.73(95%CI 20.69-28.78,P=0.01,I2=88%),MD 26.45(95%CI 22.85-30.05,P=0.01,I2=96%)for Kansas City Cardiomyopathy Questionnaire(KCCQ-OS),and MD 0.07(95%CI 0.04-0.11,P=0.01,I2=89%),MD 0.08(95%CI 0.06-0.10,P=0.01,I2=53%),and MD 0.06(95%CI 0.04-0.07,P=0.01,I2=45%)for the EuroQoL 5 Dimension score(EQ5D),and MD 5.42(95%CI 3.91-6.94,P=0.01,I2=86%),MD 6.45(95%CI 5.65-7.24,P=0.01,I2=38%),MD 7.26(95%CI 5.13-9.39,P=0.01,I2=90%)for Medical Outcomes Study Short-Form Health Survey 12(SF-12)physical component scores(PS),and MD 2.56(95%CI 1.11-4.02,P=0.01,I2=72%),MD 4.31(95%CI 3.45-5.18,P=0.01,I2=34%),MD 4.71(95%CI 3.19-6.22,P=0.01,I2=76%)for SF-12 mental component scores(MS)at 1,6,12 months.In addition,transfemoral(TF)TAVR had substantial benefits at 1,6 and 12 months post surgery.However,between non-TF(transapical,transthoracic,transaortic,subclavian)TAVR and SAVR groups,the great benefits of most health status measures occurred at 6 months post surgery.Differences become the largest between TAVR and SAVR at 1 month,however,they diaspear at 6 or 12 months after operation,with MD 10.31(95%CI 7.08-13.54,P=0.01,I2=70%),MD 0.71(95%CI-2.36-3.79,P=0.65,I2=0%),MD 0.59(95%CI-1.32-2.51,P=0.54,I2=0%)for KCCQ-OS,and MD 0.06(95%CI 0.02-0.09,P=0.01,I2=62%),and MD 0.01(95%CI-0.01-0.04,P=0.36,I2=0%),MD 0.01(95%CI-0.04-0.06,P=0.64,I2=81%)for EQ5D,and MD 3.45(95%CI 1.76-5.13,P=0.01,I2=46%),MD-0.37(95%CI-1.61-0.88,P=0.56,I2=0%),MD 0.78(95%CI-0.66-2.23,P=0.29,12=0%)for SF-12 PS,and MD 2.92(95%CI-0.23-6.07,P=0.07,I2=74%),MD 1.08(95%CI-0.33-2.50,P=0.13,I2=0%),MD 0.99(95%CI-0.70-2.68,P=0.25,I2=13%)for SF-12 MS at 1,6,12 month after surgery.Differences become the largest between TF TAVR and SAVR at 1 month,however,they diaspear at 6 or 12 months after operation by subgroup analysis.The outcomes is similar between non-TF TAVR and SAVR.Conclusion:HRQOL was improved markedly in patients with high surgical risk no matter either TAVR or SAVR was performed.Compared to non-TF TAVR and SAVR,TF TAVR achieved better,early and substantial benefits in HRQOL. |
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