ABSTRACT
AIMS: Transcatheter aortic valve implantation (TAVI) has emerged as a treatment alternative to surgical aortic valve replacement in elderly high-risk patients with symptomatic severe aortic stenosis. In this patient population, rapid improvement or restoration of quality of life (QoL) is at least as important as improved clinical outcomes. The purpose of the present study was to assess changes in QoL in response to TAVI. METHODS AND RESULTS: Between August 2007 and August 2010, 62 patients (39% females, age 83 ± 5 years) underwent TAVI and were included in this QoL study. QoL was impaired at baseline and improved in all components of physical and mental health at nine months of follow-up: physical functioning (37.0 to 59.0, p<0.0001), physical role functioning (18.3 to 49.1, p<0.0001), general health (55.9 to 64.9, p=0.001), vitality (40.7 to 51.3, p<0.001), social functioning (67.4 to 76.8, p=0.049), emotional functioning (52.0 to 75.8, p<0.001) and mental health (66.6 to 75.8, p=0.05). The subscale bodily pain (60.7 to 70.4, p=0.058) showed a strong trend to improvement, but failed to reach statistical significance. Besides changes in health-related QoL, TAVI significantly improved symptoms (NYHA class 2.6 ± 0.8 to 1.4 ± 0.6, p<0.0001). CONCLUSIONS: TAVI leads to rapid and sustained restoration of all aspects of mental and physical health and effectively alleviates symptoms.
Subject(s)
Aortic Valve/surgery , Femoral Artery , Health Status , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Mental Health , Quality of Life/psychology , Aged , Aged, 80 and over , Aortic Valve/physiopathology , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/psychology , Aortic Valve Stenosis/surgery , Endpoint Determination , Female , Follow-Up Studies , Health Surveys , Heart Valve Diseases/physiopathology , Heart Valve Diseases/psychology , Heart Valve Prosthesis , Humans , Male , Retrospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
The purpose of this study was to measure splanchnic blood flow during digestion in unsedated dogs by using duplex Doppler sonography. The study population consisted of 12 healthy dogs. Blood flow in the cranial mesenteric artery, the celiac artery, and the aorta was measured before a test meal and at 20, 60, and 90 minutes after eating. The following measurements were made or calculated: vessel diameter, peak systolic velocity, end diastolic velocity, mean velocity, resistive index, pulsatility index, and flow volume. There was a significant postprandial decrease in the resistive and pulsatility indices in both the cranial mesenteric (preprandial RI = 0.867, postprandial RI = 0.796, preprandial PI = 3.033, postprandial PI = 2.173) and the celiac (preprandial RI = 0.854, postprandial RI = 0.769, preprandial PI = 2.639, postprandial PI = 1.930) arteries. In both vessels the end diastolic velocity, the mean velocity, and the flow volume increased significantly postprandially. These changes occurred significantly earlier in the celiac artery than in the cranial mesenteric artery. The findings most likely correspond to postprandial splanchnic vasodilation. Doppler ultrasound provide a good methode of detecting changes in postprandial splanchnic blood flow in the dog.
