Physical and Mental Recovery in Patients with Severe Aortic Valve Stenosis at Low-to-Intermediate Risk: SAVR versus TAVR

Background: Severe aortic valve stenosis (AS) can be treated by surgical aortic valve replacement (SAVR) or via transcatheter aortic valve implantation (TAVI). However, the gold standard for low risk patients has not been determined. Most prospective studies focused primarily on mortality and major adverse cardiac events. Therefore, the aim of this study was to record the course of physical and mental recovery after aortic valve replacement and to compare SAVR and TAVI.

Method: A total of 222 patients (108 SAVR; 114 TAVI) scheduled for elective aortic valve replacement with a low-to-intermediate risk (STS-Score 2–6) were prospectively included in our study from 2016 to 2019. Physical (NT-proBNP, 6-minute walk test) and mental parameters (12-Item Short Form Health Survey [SF-12]; Hospital Anxiety and Depression Scale [HADS-D]) were evaluated upon admission, at discharge and at 3 and 12 months. Statistical analyses were performed using a multivariate mixed model adjusting for age, gender and procedure (SAVR vs. TAVR).

Results: SAVR patients were significantly younger compared with the TAVI group (73.5 ± 4.8 vs. 75.5 ± 4.0; p = 0.002) and had lower STS scores 2.7 (2.2–3.4) versus 3.3 (2.6–4.1); p < 0.001. Further cardiovascular risk factors were similar in both groups at baseline. With regards to physical recovery, 6MWT showed significant (p < 0.001) and similar (69.9–79.2 m) differences between SAVR and TAVI at baseline, 6 months and 12 months of follow-up. NT-proBNP values were significantly increased in the immediate postoperative interval in the SAVR group (p < 0.001). Physical QoL showed significant (p < 0.001) and similar (6.2–7.1 points) differences between SAVR and TAVI at baseline, 6 months and 12 months postoperatively. The course of anxiety was similar in both groups with a mean significant difference of 1.49 points at all measurements (p = 0.006).

Conclusion: SAVR and TAVI resulted in similar postoperative improvements in physical and mental parameters after 6 to 12 months of follow-up. Differences between SAVR and TAVI were similar during the course of measurements; except for a significant decline of physical QoL and 6-MWT in the immediate postoperative interval in the SAVR group which improved until 6 and 12 months of follow-up. A heart-team approach is mandatory to decide for the best treatment in AS patients at low to intermediate risk which consequently helps to achieve a superior physical and mental postoperative recovery.

Publication History

Article published online:
03 February 2022