Midterm Outcomes and Quality of Life of Aortic Root Replacement: Mechanical vs Biological Conduits

Objective: To assess whether postoperative quality of life (QOL) for composite aortic root replacement patients differs according to whether it is based on the use of mechanical valves or bioprosthetic valves. Methods: The study included 146 consecutive patients who underwent composite aortic root replacement at our institution from January 2010 to April 2014 with bioprosthetic (34.9%, n = 51) and mechanical (65.1%, n = 95) valves. Patient-perceived QOL was measured by administering the Short Form (SF)-36v2 Health Survey and a series of supplemental questions to further evaluate valve-specific differences. Final survey participation (n = 121) included 82.9% of the qualifying patients, and involved 76.5% (39/51) of those with bioprosthetic valves and 86.3% (82/95) of those with mechanical valves. Reasons for not completing the survey included 5 expired patients (3.4%), 1 lost due to a language barrier (0.7%), 6 who refused to participate (4.1%) and 13 who were lost to follow-up (8.9%). The mean follow-up time was 32 months (range 4-56 months). Results: Patients in the bioprosthetic valve group were older (mean age 67.5 ± 13.6 years) and included more females (25.6% or 10/39) than those in the mechanical valve group (mean age 56.6 ± 12.0 years; 11.0% or 9/82 were female). No significant differences were found between the bioprosthetic and mechanical valve groups for any QOL aspects scored by the SF-36v2 survey. All 8 domains and 2 summary scales comprising the QOL evaluation were above national norms calculated using gender- and age-matched, norm-based scoring for a standard national average of 50. The supplemental questions indicated satisfaction with each valve type despite characteristics that were of concern to patients. In the mechanical valve group, 90.2% (74/82) reported that the audible valve click was not troublesome, 85.4% (70/82) that taking a blood thinner regularly did not affect daily life and 81.7% (67/82) that blood testing for anticoagulation therapy was not troublesome. Conclusions: Receiving a tissue or a mechanical valve does not directly affect postoperative QOL. Answers to supplemental questions suggest that prior concerns with mechanical valves do not affect patients in the commonly anticipated negative manner. The preconception of a heavy QOL burden for mechanical composite grafts is contradicted by this study.

Download Full-text

Quality-of-life in valve-sparing aortic root replacement versus mechanical composite graft procedure

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1038039 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

ES Krähenbühl ◽

FS Schönhoff ◽

A Kadner ◽

FF Immer ◽

FS Eckstein ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Root ◽

Composite Graft ◽

Aortic Root Replacement ◽

Valve Sparing

Download Full-text

Valve-sparing aortic root replacement—midterm outcomes and quality of life

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2017.08.02 ◽

2017 ◽

pp. 572-580 ◽

Cited By ~ 2

Author(s):

Abdel-Kémal Bori Bata ◽

Nicolas D’Ostrevy ◽

Bruno Pereira ◽

Etienne Geoffroy ◽

Nicolas Dauphin ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Root ◽

Aortic Root Replacement ◽

Valve Sparing

Download Full-text

Abstract 9979: Health-Related Quality of Life in Children With Marfan Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.9979 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jill C Handisides ◽

Danielle Hollenbeck-Pringle ◽

Karen Uzark ◽

Felicia L Trachtenberg ◽

Victoria L Pemberton ◽

...

Keyword(s):

Quality Of Life ◽

At Risk ◽

Marfan Syndrome ◽

Aortic Root ◽

Sample Mean ◽

Population Norms ◽

Patient Reported ◽

Health Related ◽

The Impact

Background: Marfan syndrome (MFS) is an autosomal dominant disorder that affects the heart, aorta, eyes, skeleton, lungs, and other organs. Objective: To assess quality of life (QL) in a large multicenter cohort of children with MFS. Methods: The Pediatric Quality of Life Inventory (PedsQL) was administered to 256 subjects with MFS ages 5-18 years as an ancillary study to the Pediatric Heart Network’s Marfan Trial, which compared the effects of atenolol vs. losartan on aortic root growth. PedsQL scores were compared to population norms by one-sample t-tests. Scores > 1 SD below the population sample mean represent at-risk status for impaired health-related QL. The impact of treatment arm (atenolol vs. losartan), severity of clinical features, and patient-reported symptoms on QL was assessed by general linear models. Results: The subjects had a mean age of 11.8±3.9 years and were 62% male, 84% white, and 88% non-Hispanic. Mean PedsQL scores for MFS subjects were significantly lower than population norms. Overall, scores were in the impaired range for physical QL and psychosocial QL in 34% and 27% of subjects, respectively. QL across multiple domains correlated negatively with frequency of patient-reported symptoms (r=0.32-0.40, p<.0001). Subjects with a reported neurodevelopmental disorder (mainly learning disability, attention deficit disorder, and/or hyperactivity) had lower mean QL scores (5.5-7.4 lower, p<.04). There were no significant differences in QL scores between treatment arms. We found no significant association between QL and aortic root z-score, extent of skeletal involvement, or presence of ectopia lentis. Conclusions: Children with MFS are at risk for impaired QL. Higher number of patient-reported symptoms had the greatest negative impact on QL, rather than treatment arm or severity of cardiac, skeletal, or ocular findings. Future interventions to address patient symptoms and neurodevelopmental disorders could improve QL for children with MFS.

Download Full-text

Quality of Life After Aortic Root Surgery: Reimplantation Technique Versus Composite Replacement

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2010.07.067 ◽

2010 ◽

Vol 90 (6) ◽

pp. 1869-1875 ◽

Cited By ~ 19

Author(s):

Ulrich F.W. Franke ◽

Anne Isecke ◽

Ragi Nagib ◽

Martin Breuer ◽

Jens Wippermann ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Root ◽

Aortic Root Surgery

Download Full-text

IMPACT OF AORTIC ROOT REPAIR ON QUALITY OF LIFE IN PATIENTS WITH MARFAN SYNDROME: COMPARISON OF VALVE-SPARING VERSUS VALVE-REPLACEMENT PROCEDURES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31104-5 ◽

2018 ◽

Vol 71 (11) ◽

pp. A563

Author(s):

Meghana Helder ◽

Hartzell Schaff ◽

Brian Lahr ◽

D. Craig Miller ◽

Heidi Connolly

Keyword(s):

Quality Of Life ◽

Marfan Syndrome ◽

Valve Replacement ◽

Aortic Root ◽

Root Repair ◽

Valve Sparing ◽

Aortic Root Repair

Download Full-text

Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old

Annals of Cardiothoracic Surgery ◽

10.21037/acs.2019.04.07 ◽

2019 ◽

Vol 8 (3) ◽

pp. 372-382

Author(s):

Arjen L. Gökalp ◽

Frederiek de Heer ◽

Jonathan R. G. Etnel ◽

Jolanda Kluin ◽

Johanna J. M. Takkenberg

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Adult Patients ◽

Life Outcomes ◽

Quality Of Life Outcomes ◽

Aortic Root Surgery

Download Full-text

Valve-sparing aortic root reconstruction

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2021-1-157-161 ◽

2021 ◽

Vol 23 (1) ◽

pp. 157-161

Author(s):

A. S. Ivanov ◽

G. A. Akopov ◽

T. N. Govorova ◽

M. K. Lugovsky

Keyword(s):

Quality Of Life ◽

Aortic Root ◽

Oral Anticoagulants ◽

Laboratory Control ◽

Hemostasis System ◽

Valve Sparing ◽

Direct Acting ◽

Direct Acting Oral Anticoagulants

This paper reviews the current main approaches to valve-sparing aortic root reconstruction. The advantages of valve-sparing surgeries are obvious - low mortality, longer survival, better quality of life of the operated patients, since the techniques save the heart's pumping reserves and free the patient from continuous intake of direct-acting oral anticoagulants and laboratory control of the hemostasis system, as well as other prosthesis-associated specific complications.

Download Full-text