Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement
DOI:
https://doi.org/10.1532/hsf.5621Keywords:
aortic valve surgery, quality of life, effective orifice areaAbstract
Background: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. Methods: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65–0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. Results: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). Conclusions: Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.
References
Tseng EE, Lee CA, Cameron DE, Stuart RS, Greene PS, Sussman MS, et al]. Aortic valve replacement in the elderly. Risk factors and long-term results. Annals of Surgery. 1997; 225: 793–802; discussion 802–804.
Dawson J, Doll H, Fitzpatrick R, Jenkinson C, Carr AJ. The routine use of patient reported outcome measures in healthcare settings. British Medical Journal. 2010; 340: c186.
Deshpande PR, Rajan S, Sudeepthi BL, Abdul Nazir CP. Patient-reported outcomes: A new era in clinical research. Perspectives in Clinical Research. 2011; 2: 137–144.
Shan L, Saxena A, McMahon R, Wilson A, Newcomb A. A systematic review on the quality of life benefits after aortic valve replacement in the elderly. The Journal of Thoracic and Cardiovascular Surgery. 2013; 145: 1173–1189.
Blokzijl F, Houterman S, van Straten BHM, Daeter E, Brandon Bravo Bruinsma GJ, Dieperink W, et al]. The impact of surgical aortic valve replacement on quality of life-a multicenter study. The Journal of Thoracic and Cardiovascular Surgery. 2021; 161: 1204–1210.e7.
Surman TL, Abrahams JM, Kim J, Surman HE, Roberts-Thomson R, Montarello JM, et al]. Quality of life and frailty outcomes following surgical and transcatheter aortic valve replacement. Journal of Cardiothoracic Surgery. 2022; 17: 113.
Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978; 58: 20–24.
Dumesnil JG, Honos GN, Lemieux M, Beauchemin J. Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography. Journal of the American College of Cardiology. 1990; 16: 637–643.
Hoffmann G, Abraham-Westphal S, Attmann T, Frank D, Lutter G, Cremer J, et al]. Impact of Patient-Prosthesis Mismatch following Aortic Valve Replacement on Long-Term Survival and Quality of Life. The Thoracic and Cardiovascular Surgeon. 2020; 68: 124–130.
Tully PJ, Aty W, Rice GD, Bennetts JS, Knight JL, Baker RA. Aortic valve prosthesis-patient mismatch and long-term outcomes: 19-year single-center experience. The Annals of Thoracic Surgery. 2013; 96: 844–850.
Chen J, Lin Y, Kang B, Wang Z. Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch. European Journal of Cardio-thoracic Surgery. 2014; 45: 234–240.
Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of Life Research. 1993; 2: 153–159.
EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16: 199–208.
Petit-Eisenmann H, Epailly E, Velten M, Radojevic J, Eisenmann B, Kremer H, et al]. Impact of Prosthesis-Patient Mismatch on Long-term Functional Capacity After Mechanical Aortic Valve Replacement. The Canadian Journal of Cardiology. 2016; 32: 1493–1499.
Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al]. EuroSCORE II. European Journal of Cardio-Thoracic Surgery. 2012; 41: 734–744; discussion 744–745.
Mannacio VA, Mannacio L, Antignano A, Pinna GB, Giordano R, Mottola M, et al]. Impact of different values of prosthesis-patient mismatch on outcome in male patients with aortic valve replacement. Journal of Cardiovascular Medicine. 2017; 18: 366–373.
Swinkels BM, de Mol BA, Kelder JC, Vermeulen FE, ten Berg JM. Prosthesis-Patient Mismatch After Aortic Valve Replacement: Effect on Long-Term Survival. The Annals of Thoracic Surgery. 2016; 101: 1388–1394.
Sportelli E, Regesta T, Salsano A, Ghione P, Brega C, Bezante GP, et al]. Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients? Journal of Cardiovascular Medicine. 2016; 17: 137–143.
Mohty D, Dumesnil JG, Echahidi N, Mathieu P, Dagenais F, Voisine P, et al]. Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction. Journal of the American College of Cardiology. 2009; 53: 39–47.
Dahlbacka S, Laakso T, Kinnunen EM, Moriyama N, Laine M, Virtanen M, et al]. Patient-Prosthesis Mismatch Worsens Long-Term Survival: Insights From the FinnValve Registry. The Annals of Thoracic Surgery. 2021; 111: 1284–1290.
Playford D, Stewart S, Celermajer D, Prior D, Scalia GM, Marwick T, et al]. Poor Survival with Impaired Valvular Hemodynamics After Aortic Valve Replacement: The National Echo Database Australia Study. Journal of the American Society of Echocardiography. 2020; 33: 1077–1086.e1.
