Abstract 19120: Preoperative Symptoms Predict Improvement in Health-related Quality of Life After Surgery for Severe Aortic Stenosis, While Preoperative Echocardiographic Parameters Do Not
Introduction: Symptoms and echocardiographic assessment of the heart and the aortic valve are key factors in the pre-operative decision-making process in patients with severe aortic stenosis (AS). Improved survival and HRQoL are primary goals after surgical aortic valve replacement (SAVR). In this study, we report changes in HRQoL one year after SAVR and study the association between symptoms, echocardiographic measures, and change in HRQoL.
Methods: In a prospective cohort study of 480 patients with severe AS, 327 patients have been to follow-up at one year, and of these 276 patients have had SAVR. Mean age was 74 years, and 40 % (111) were female. HRQoL was measured using Short-Form 36 (SF-36). Response rate was > 90%. Patients` answers on type (fatigue, dyspnea, chest pain or dizziness) - and frequency (last week) of cardinal AS-symptoms were used to create three patient groups based on estimated total symptom load. We used valve area, mean pressure gradient, cardiac output, ejection fraction, and estimated systolic pulmonary artery pressure as echocardiographic measures of heart function and AS characteristics.
Results: Mean valve area was 0.7 cm2, mean pressure gradient was 53 mmHg, mean maximum valve velocity 4.5 m/s, mean estimated systolic pulmonary artery pressure 36 mmHg, cardiac output 5,2 m/s, and 89 % had normal ejection fraction.
There was a statistically significant improvement in HRQoL one year after SAVR in six of the eight SF-36 scales. Physical Functioning: (mean pre-operative - mean post-operative score) 61 - 72 p < 0.001, Role-physical Functioning: 52 - 62 p < 0.001, Bodily Pain: 65 - 74 p < 0.001, General Health: 58 - 71 p < 0.001, Vitality: 48 - 56 p < 0.001, Social Functioning: 78 - 81 p = 0.2, Role-emotional Functioning: 77 - 80 p = 0.2, Mental Health: 77 - 80 p = 0.02. There was no association between the echocardiographic parameters and change in HRQoL.
Conclusions: There was a substantial gain in HRQoL after SAVR. Despite their importance in the pre-operative assessment, echocardiographic measures did not predict change in HRQoL. After SAVR, patients with more symptoms experience the greatest yield in HRQoL, and amount of AS-symptoms is a strong predictor of intermediate HRQoL.
Author Disclosures: A. Auensen: None. A. Hussain: None. M. Rognstad: None. M. Rognstad: None. S. Aakhus: None. S. Aakhus: None. J. Beitnes: None. L. Gullestad: None. K. Pettersen: None.
- © 2014 by American Heart Association, Inc.