Analysis Of Quality Of Life For Patients After Aortic Valve Replacement

ObjectiveTo discuss the quality of life and its influencing factors in patients after aortic valve replacement.To analyze effect of mortality in hospital,morbidity,hospitalization period,hemodynamic,mortality outside of hospital,cardiovascular adverse events, quality of life of patients who had phnomenon of prosthesis-patient mismatch after surgery.To assess the effect of aortic flow rate,meantransvalvular pressure,and risk factors for recurrence of heart failure after aortic valve replacement in the early. MethodsTo retrospective analysis of 89 patients after simple aortic valve replacement from January 2012 to January 2015 in our hospital,to understand quality of life with the Short Form Health Survey when it was before surgery and 1 year after aortic valve replacement surgery,to analyze influencing factors of quality of life by using multiple linear regression analysis;to obtain the incidence of secondary of symptoms,the function of cardiac and cardiovascular adverse events by the Short Form Health Survey.The 89 patients were divided into two groups which were match group and mismatch group according to effective orifice area index(the patient whose effective orifice area index less than or equal to 0.85cm2/m2 was prosthesis-patient mismatch,to measure each individual patient’s body surface area and effective orifice area before surgery).To compare hemodynamic,mortality in hospital,morbidity,mortality outside of hospital,cardiovascular adverse events,hospitalization period,quality of life of patients of two groups.To compare differences by univariate analysis that was age,sex,body surface area,body mass index,left ventricular dysfunction,effective orifice area,aortic peak velocity,mean transvalvular pressure,postoperative EF value,thickness of septal and left ventricular, diameter of left ventricular end-diastolic and end-systolic,biological valve replacement of patients who had symptom or without;The meaningful variable was analysis by logistic regression.To assess the effect of aortic flow rate,the mean transvalvular pressure,and risk factors for recurrence of heart failure after aortic valve replacement in the early. ResultsThere were 89 patients and 6 patient died.the average total score of Quality of Life Scale for patients who was complete follow-up was 478.43±142.14 by the Short Form Health Survey,it was showed that quality of life of patients was significantly improved after 1 year after surgery from baseline survey,higher than that before the surgery in 8 dimensions.Obtained by univariate analysis of quality of life:the score was significantly different of patients who had different of preoperative EF, NYHA classification, and different mass index(p<0.001);the higher LVEF value and the larger effective orifice area index,the higher scores;the scores of patients were lower who had bioprosthesis,obesity and the high mean transvalvular pressure,there was statistically significant for the difference(p<0.05);the results of multivariate analysis:there was positive correlation between quality of life and preoperative LVEF values and the effective orifice area size and there was negatively correlation with body mass index and mean transvalvular pressure.There were 25(28.1%) patients who was prosthesis-patient mismatch and two patients with severe mismatch;There was a statistic difference(p<0.05) in sex,body surface area,the kind of prosthesis(bioprosthesis) between match group and mismatch group;and there was statistically significant for the difference(p<0.05) about hospitalization period between match group and mismatch group,mismatch patients prolonged hospitalization.The match group was lower in some ways that was the mean pressure gradient,the aortic flow velocity and the maximum pressure gradient,the difference was statistically significant(p<0.05). The survival rate of the mismatch group is significantly higher than the match group(p=0.027) analyzed by Kaplan-Meier method and Log-rank. And there was significant difference in cardiovascular adverse event-free incidence between the two groups(p<0.001).there was a significant impact with mortality outside of hospital,cardiovascular adverse events and quality of life on patients who had prosthesis-patient mismatch after surgery.There were 28 patients with heart failure symptoms,mismatch rate was 65.6% in symptoms group, and 7.1% in asymptomatic group;age,female,body mass index(BMI≥25kg/m2),left ventricular function impaired(EF<50%) were the preoperative risk factors of patients who had experienced symptoms;biological valve,high mean transvalvular pressure gradient(>10mm Hg),and high cross flow velocity(>3m/s) were postoperative risk factors.The logistic regression analysis showed that left ventricular function impaired(p=0.040, OR=1.57), and the high mean transvalvular pressure gradient( p=0.002,OR=3.34) were independent risk factors for postoperative patients with symptoms. Conclusions1.There was improvement of quality of life in patients with early postoperative compared with the preoperative,However,preoperative left ventricular dysfunction, obesity,prosthesis-patient mismatch,high postoperative mean transvalvular pressure could influence the quality of life of patients.2.There was a common phenomeno of prosthesis-patient mismatch after surgery,it could prolong hospitalization and increase the rate of mortality outside of hospital and cardiovascular adverse events.3.Patients with low EF will be a higher risk of heart failure symptoms after operation, at the same time, the high mean transvalvular pressure gradient is an independent risk factor for heart failure after aortic valve replacement.In the early stage, we should pay more attention to the change of the mean transvalvular pressure gradient and improve the quality of life of patients.