article on mechanical vs. prosthetic aortic valves

[bvdr]

--------------------------------------------------------------------------------

Surgery for acquired cardiovascular disease

Quality of life after aortic valve replacement with tissue and mechanical implants
Artyom Sedrakyan, MDa, Patricia Hebert, PhDb, Viola Vaccarino, MD, PhDc, A. David Paltiel, PhDa, John A. Elefteriades, MDd, Jennifer Mattera, MPHe, Zhenqiu Lin, PhDe, Sarah A. Roumanis, RNe, Harlan M. Krumholz, MDa,b,e,*
a Division of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn, USA
b Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA
c Department of Medicine, Division of Cardiology, Emory University School of Medicine, and Rollins School of Public Health, Atlanta, Ga, USA
d Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn, USA
e Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn, USA

This study was presented at the 3rd Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Oct 1, 2001, Washington, DC.

Received for publication September 25, 2003; revisions received December 10, 2003; accepted for publication December 15, 2003. * Address for reprints: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088, USA
[email protected]

OBJECTIVES: We sought to determine whether changes in quality of life at 18 months following aortic valve replacement differ depending on the use of tissue valves or mechanical valves.

METHODS: We prospectively studied 73 patients with tissue valve replacements and 53 patients with mechanical valve replacements performed from April 1998 through March 1999 at Yale-New Haven Hospital. Quality of life was measured at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-Item Health Survey.

RESULTS: Baseline unadjusted mean quality-of-life scores were lower in tissue valve recipients than in mechanical valve recipients and, for both groups, were generally lower than US population norms. At 18 months postoperatively, quality-of-life scores were greatly improved in both groups and were comparable to population norms (ie, within one-half a standard deviation). After adjusting for baseline quality of life, age, and other prognostic factors in an analysis of covariance, improvements in quality-of-life scores for tissue valve recipients versus mechanical valve recipients were similar. Of 10 (8 domains and 2 summary) scales examined, the only significant difference between the 2 groups was for the improvement in role limitations due to physical problems (Role Physical), which was more favorable in patients with mechanical valve implants (P = .04).

CONCLUSIONS: The use of tissue valve implants versus mechanical valve implants has little influence on improvement in quality of life at 18 months following aortic valve replacement. Thus, decisions about whether to choose a tissue valve or mechanical valve implant should depend upon other factors such as rates of complications and differences in the life span of the implants.

 

[tobagotwo]

One of the reasons for this result is that tissue valves have been traditionally given to a much older population, for whom recovery is generallly more difficult and less physically satisfying. Mechanical valves have traditionally been given to the young, who bounce back much more readily from surgery, delighted to have their energy back. Even so, the results balance out over 18 months.

Another study, with 857 participants...

85. Quality of Life After Heart Valve Replacement - A Comparison of Patients with Biological Versus Mechanical Heart Valves
Heinrich Koertke1, Inge Kirchberger2, Kazutomo Minami1, Nikolas Mirow1, Bert Hansky1, Reiner Koerfer1
1Clinic for for Thorax and Cardiovascular Surgery, Heart Center Northrhein Westfalia, Bad Oeynhausen, Germany, 2QUALI-team, Research and Consulting in Health and Social Sciences, Augsburg, Germany

--------------------------------------------------------------------------

OBJECTIVE: Heart valve replacement is the second most common procedure in cardiac surgery. The vast majority of the implanted heart valves are mechanical, with bioprosthetic heart valves accounting for a relatively small percentage. Biological heart valves have a life of 6 to 12 years, whereas mechanical heart valves necessitate long-term anticoagulation therapy. Outcome measurements of heart valve surgery concentrated on survival time and complication rate whereas the Quality of life (QoL) has not yet been studied in detail.

METHODS: We conducted a cross-sectional study which included all 1.862 patients having undergone heart valve replacement at the Heart Center Northrhein-Westfalia during the years 1991 to 1993. The SF-36 Health Survey was sent to 1.676 patients and had been returned by 83,4% of the patients. A sample of 857 patients was then selected by chance and clinical data of these patients were collected. 404 patients had received a biological valve, 453 a mechanical valve.

RESULTS: The results showed that patients after heart valve replacement still suffer from a reduced QoL especially in the SF-36 subscales "Physical functioning", "Role-physical" and "Role-emotional" compared to the German normal population. Patients with mechanical heart valve reported a better QoL in all dimensons due to their significantly lower age. Analysis of covariance considering age, gender, position of the valve and time between operation and QoL assessment showed no significant differences in QoL of patients with mechanical versus biological valves.

CONCLUSION: The results emphasize the importance of quality of life as an outcome variable in clinical trials and the worth of norm-based comparisons.