Factors influencing quality-of-life improvement following transcatheter aortic valve implantation: insights from a prospective study with mixed-effects analysis.

Abstract

Aim: To identify risk factors that may be associated with lack of improvement in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: We analyzed data from 116 patients with severe aortic stenosis (AS) undergoing TAVI in a tertiary center. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and then at 1-3 months (first follow-up with a bounded time frame), 6 months and 12 months after the procedure. The primary outcome was the MLHFQ score, with higher scores indicating worse QoL. Mixed-effects modeling was used to evaluate predictors of longitudinal changes in QoL.

Results: The mean MLHFQ score improved significantly from 41.1 ± 16.6 at baseline to 23.4 ± 10 at 12 months (P < 0.001), indicating enhanced QoL post-TAVI. However, several variables were associated with worse QoL trajectories over time. These included peripheral artery disease (PAD), paravalvular leak (PVL) ≥ grade 2, contrast-induced nephropathy, moderate-to-severe tricuspid regurgitation, pulmonary hypertension (PH), elevated creatinine, lower hemoglobin, reduced left ventricular ejection fraction, and increased left atrial diameter. PAD and PVL were consistent predictors of impaired QoL both early and late after TAVI.

Conclusion: TAVI significantly improves QoL in most patients with severe AS, but certain comorbidities and complications - particularly PAD, PVL, and PH are associated with suboptimal recovery. Identifying these risk factors may help guide individualized follow-up and supportive strategies to optimize patient-centered outcomes.