A prospective study of changes in patients' qulaity of life after aortic valve replacement

Background and aim of the study: After aortic valve replacement (AVR), 90% of survivors are in NYHA class I or II, and most return to work after three months. It is unclear, however, whether at that time patients have an improved quality of life (QOL), are able to perform physical and social activities, and live independently. Methods: To assess this situation, 62 patients (39 males, 23 females; mean age 68.5 +/- 10 years) who underwent primary AVR completed the validated Short Form 36 (SF-36) questionnaire. QOL parameters were determined before and three months after surgery prospectively, and analyzed using the Wilcoxon matched pairs rank test. Results: All patients showed significant improvement in all eight QOL parameters (score 0-100): (i) physical function (67 +/- 26 versus 37 +/- 28; p <0.00001); (ii) role limitation due to physical function (52 +/- 43 versus 20 +/- 37; p <0.0001); (iii) social function (80 +/- 25 versus 59 +/- 30; p <0.0001); (iv) role limitation due to emotional problems (64 +/- 41 versus 41 +/- 46; p = 0.01); (v) energy (62 +/- 22 versus 42 +/- 23; p <0.00001); (vi) mental health (78 +/- 19 versus 63 +/- 22; p <0.00001); (vii) pain (78 +/- 27 versus 67 +/- 32; p = 0.02); and (viii) general health perception (72 +/- 20 versus 58 +/- 21; p <0.00001). Significant improvements in QOL parameters were: (i) after mechanical and bioprosthetic AVR, seven of eight QOL parameters were improved; (ii) patients aged <70 years had pronounced improvement in six of seven parameters, while those aged greater than or equal to 70 years had limited improvement in five of eight parameters; (iii) patients with valve sizes 19 and 21 mm. improved in five of eight parameters, while those with greater than or equal to 23 mm implants improved in all eight parameters, regardless of post-AVR peak gradient of <20 or greater than or equal to 20 mmHg; and (iv) patients with left ventricular end-diastolic dimension (LVEDD) <55 mm improved in all eight parameters while those with LVEDD greater than or equal to 55 nun improved in only five parameters. Conclusion: There was significant improvement in patients' QOL at three months after AVR, regardless of the type of aortic implant used; improvement was greatest in those aged <70 years. The results also suggest that patients with smaller implants (who were older) and those with LVEDD greater than or equal to 55 mm were less likely to show significant improvement in all QOL parameters at three months after AVR.