Quality Of Life And Anxiety In Younger Patients After Biological vs. Mechanical Aortic Valve Replacement
Marc Kottmaier, Sabine Bleiziffer, Ina Hettich, Catalin C. Badiu, Ruediger Lange.
German Heart Center, Munich, Germany.
OBJECTIVE: Since biological valve recipients are likely to need a redo procedure in the future for valve deterioration, we hypothesized patients might be more fearful about the progression of their disease than patients after aortic valve replacement (AVR) with a mechanical valve. Aim of this study is to compare Quality of life (QoL) in patients who have undergone biological versus mechanical AVR.
METHODS: Fifty-six patients after mechanical AVR (Medtronic ADVANTAGE) (mean age 64.4+/-8.17 years) and 66 patients after biological AVR (Edwards-Perimount Magna Ease) (mean age 64.8+/-11.05 years) received three questionnaires eight to two years after surgery:
The Short Form-36 (SF-36) to assess mental and physical QoL, and the Fear of Progression Questionnaire (FoP) and the Cardiac anxiety questionnaire (CAQ) to assess general anxiety, anxiety related to cardiac symptoms and anxiety about progression of heart disease.
RESULTS: Thirty-seven (mechanical AVR) and fifty-four (biological AVR) questionnaires were suitable for analysis. Sumscores are listed in the table (* higher scores correspond to high anxiety (FoP) and avoidance (CAQ)). No significant differences were found for all categories of the SF-36. The FoP showed significantly favourable values for the biological AVR group. The CAQ showed a tendency in the subscale “avoidance” towards favourable values for the biological AVR group.
| biological AVR mean (SD) n=54 | mechanical AVR mean (SD) n=37 | P-value | |
| SF-36 Physical sum score | 46.87 (10.06) | 45.42 (12.39) | p=0.554 |
| SF 36 Mental sum score | 53.06 (10.86) | 51.80 (8.67) | p=0.541 |
| FoP sum score* | 6.26 (1.77) | 7.22 (2.47) | p=0.052 |
| FoP Partnership*subscale | 1.59 (0.56) | 2.12 (0.75) | p=0.001 |
| CAQ sum score* | 1.17 (0.63) | 1.40 (0.69) | p=0.096 |
| CAQ Avoidance*subscale | 1.22 (1.10) | 1.65 (1.19) | p=0.078 |
CONCLUSIONS: In contrast to our hypothesis, patients after mechanical AVR show significantly higher anxiety values for the FoP, and a tendency towards higher values for “avoidance” (i.e. avoidance of pulse increase). Partnership concerns, especially in terms of sexuality can be explained by factors that are recognizable for the partner, such as valve sound. These data provide evidence that factors that are continuously present after mechanical AVR, such as valve sound or anticoagulation might affect wellbeing stronger than the certainty of re-operation in the future after biological AVR.
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