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10 The Impact ofValve Surgery ontheHealth-Related Quality ofLife ofElderly Patients: Systematic Review

Quality

score

Physical

component

improved

QoL

Instruments Conclusion

Physical activity

was statistically

signicantly

worse in the MV

replacement and

repair groups

Survival is longer

after MV repair than

after

MV replacement.

The quality of life

of not differ from

Health Prole

than in the

each other

reference

population

N/A-No

comparison with

pre or norms

operative risk and

greater morbidity,

QOL

indicators in

patients ≥80years

were equivalent to

Younger valve

repair patients

and Ross patients

scored

or better than their

counterparts

quality of life is

inuenced by the

type of aortic valve

SF36 Postoperative

signicantly

better than the

patients after

mechanical valve

replacement in

all four physical

procedure and is

negatively linked

with mechanical

prosthesis

implantation and

long-term

subscales

anticoagulation

195

(continued)

Follow-up duration

(mean)

7.3±1.4 Nottingham

No. of

patients at

baseline Age of patients

184 MV Repair:

Prospective

Type of cardiac

valve procedure Study type

MV Repair:

Author, year,

Reference

Jokinen,

62.2±9.2

Replacement:

cohort

(n=85)

Replacement:

2007 [36]

61.3±9.4

(n=99)

58 83.7±3.4 35.3±25.3 SF36 Despite higher

Prospective

Cohort

Aortic Valve

replacement in

>80years age

(n=58)

Lam, 2004

[20]

Median

26.9months

Aortic valve-

sparing

procedure,

age<50

139

Cross

sectional

study

Aortic

valve-sparing

procedure,

age<50

Zacek, 2016

[29]

36.3±6.1

Aortic valve-

sparing

(n=36)

Aortic

valve-sparing

procedure,

age>50

59.2±7.7

Ross procedure

procedure,

age>50

(n=52)

Ross procedure

37.8±11.9

Mechanical

aortic valve

replacement

(n=22)

Mechanical

aortic valve

replacement

39.7±7.3

(n=29)

196

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Quality

score

Physical

component

improved

QoL

Instruments Conclusion

Quality of life

following mitral

valve surgery is

suboptimal in more

than half of elderly

Living

with Heart

Failure

(MLHF)

patients. MLHF

score at follow-up is

mostly related to

preoperative

conditions. Type of

questionnaire

surgery does not

inuence MLHF

score, however,

quality of life is

worse in patients

Assessment of

QoL revealed a

with recurrent/

residual MR

following repair

Surgery

in the aortic valve

Questionnaire

substantial

improvement of

physical tness

in all 126

patients (who

survived to be

without CABG is

associated with a

good outcome. The

improvement in

QoL after one year

supports the

Y. S. Abdullahi et al.

followed up at

1year)

decision to

operate on patients

older than 80years

of age

Follow-up duration

No. of

patients at

Type of cardiac

Author, year,

Table 10.2 (continued)

(mean)

baseline Age of patients

225 77±3.2years 2.8±1.2years Minnesota

Retrospective

Cohort

valve procedure Study type

Isolated mitral

valve surgery

(n = 225)

sub study

Reference

Maisano,

2009 [23]

(Combination

aortic/mitral

valve surgery)

(n = 208)

154 82.9±2.5 1year Seattle Angina

Retrospective

Cohort

AvR with

CABG

(n=80)

AvR without

CABG

Folkmann,

2010 [11]

(n=74)

10 The Impact ofValve Surgery ontheHealth-Related Quality ofLife ofElderly Patients: Systematic Review

Quality

score

Physical

component

improved

QoL

Instruments Conclusion

PCS increased

from baseline for

both group at

1year follow up

replacement in

octogenarians could

be performed with

very low mortality,

and with a relevant

and signicant

increase of the

quality of life

N/A-No

comparison with

towards normal

values

after AVR in

pre or norms

selected

octogenarians was

similar to that of the

general elderly

population. The

N/A-No

device type exerted

no inuence on

QOL

comparison with

pre or norms

survivors reported

that their activity

level was equal to or

better than the

preoperative level

achieved

improvement of

QoL and remained

autonomous

197

Follow-up duration

(mean)

1year SF-36 Surgical aortic valve

No. of

patients at

baseline Age of patients

762 Age<80

Prospective

Type of cardiac

valve procedure Study type

Age<80

Author, year,

Reference

Klomp,

71 (66–75)

Age>80

82 (81–83)

single-canter

cohort study

N=597

Age>80

N=163

2016 [34]

3.4±2.8 SF-36 Long-term survival

group:

82.9±2.7

Mechanical

160 Bioprosthetic

Retrospective

cohort

Bioprosthetic

AV R

N=62

Mechanical

Vicchio,

2007 [30]

group:

81.8±1.8

AV R

N=98

60 82.3±1.9 3.4±3.1years Some 97.6% of late

Aoyagi,

2010 [35]

114 78.5±2.5years 47.2±23.4months At follow-up, most

Retrospective

cohort

>75year old

patients that

underwent

AV R

Oliveira,

2011 [33]

(n=114)

198

Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/

Quality

score

Physical

component

improved

TAVI better

over the rst

year

physical and mental scores in TAVI

group at 1month. No difference at

1year

TAVI better

over the rst

year

physical and mental scores in TAVI

group at 1month. At 6months

statistically signicant difference

in mental score. No difference at

Both showed

1year

similar

improvement

in QoL

KCCQ and they have shown a

signicant improvement for both

TAVI and sAVR at 24months of

follow-up

Comparable

improvement

in QoL

associated with signicant

improvements in both disease-

specic (16–22 points in the

KCCQ-OS scale) and generic

health status (3.9–5.1 points in the

SF-36 physical scale). There were

no signicant differences between

Y. S. Abdullahi et al.

TAVI better

over the rst

year

TAVI and sAVR in any health

status measures at 1- or 2-year

follow-up

TAVI patient showed the more

rapid improvement in all QoL

metrics

Follow-up

duration

(mean) HRQOL Instruments Conclusion

No. of

patients at

baseline

Study

type

Table 10.3 RCT trial studying Aortic valve surgery and QoL

Author, year, Ref Intervention

5year SF-12, EQ-5D, KCCQ Greater improvement on both

(n=348)

SAVR

(n=351)

RCT TAVI

TAVI vs

SAVR

PARTNER1A –

surgically

operable at high

risk

(Mack etal.

5years SF-12, KCCQ Greater improvement on both

(n=394)

SAVR

RCT TAVI

TAVI vs.

SVAR

2015) [45]

US CoreValve

Trial- surgically

operable at high

2years KCCQ The QoL was assessed using the

(n=401)

risk (Deeb etal.

2016) [46]

(n=864)

RCT TAVI

TAVI vs.

SAVR

SURTAVI

Trial-surgically

SAVR

(n=796)

operable at

intermediate risk

(Reardon etal.

2017) [47]

2years SF-36, EQ-5D, KCCQ Both TAVI and sAVR were

(n=950)

SAVR

RCT TAVI

TAVI vs.

SAVR

PARTNER

2–surgically

operable at

(n=883)

intermediate risk

(Baron etal.

2017) [48]

test

1year KCCQ, NYHA class, 6min walk

(n=496)

RCT TAVI

TAVI vs.

SAVR

PARTNER

3–surgically

SAVR

operable at low

(n=454)

risk

(Mack etal.

2019) [49]

10 The Impact ofValve Surgery ontheHealth-Related Quality ofLife ofElderly Patients: Systematic Review

Quality

score

Physical

component

improved

TAVI and

surgery similar

over rst year

the composite end point of death or

disabling stroke at 24months

In relation to QoL analysis,

assessed using the KCCQ, both

TAVI and surgery offered similar

functional improvement at

12months, with better early,

NA 11

30-day recovery observed in the

TAVI group

Pain scores similar

Lung function better

NA 12

Pain scores reduced

Blood loss reduced

ITU and total length of stay

reduced

Less post-op ventilation

199

(continued)

Follow-up

duration

No. of

patients at

Study

(mean) HRQOL Instruments Conclusion

1year KCCQ TAVI was non-inferior to sAVR for

baseline

(n=725)

type

RCT TAVI

TAVI vs.

SAVR

Author, year, Ref Intervention

EVOLUT

trial– surgically

SAVR

(n=678)

operable at low

risk (Popma etal.

2019) [50]

Primary outcomes: cross-clamp

and pump times, time to extubation,

chest drainage (24h), number of

blood transfusions,

ICU stay,

total postoperative length of stay

Secondary outcomes:

pain scores (daily) and cosmetic

evaluation (discharge)

(n=20)

Full

(n=20)

RCT Limited

Limited vs

Full

sternotomy

Aris etal. 1999

[51]

Outcomes:

in-hospital death, re-exploration for

bleeding, mean mediastinal drainage

or bleeding >800mL, blood

transfusion, atrial brillation,

atelectasis, respiratory insufciency,

sternal wound infection, sternal

instability, mechanical ventilation

time, oxygen requirements (pre- and

post extubation), pain scores (1 and

Peri

operative

assessment

(n=40)

Full

(n=40)

RCT Limited

Limited vs

Full

sternotomy

Bonacchi etal.

2002 [52]

12h), analgesia requirements, ICU

stay, hospital stay, spirometry

(5days and 1 to 2months)

200

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Quality

score

Physical

component

improved

Y. S. Abdullahi et al.

NA 12

Follow-up

duration

No. of

patients at

Study

QoL scores similar NA 14

Primary outcomes: cross-clamp

and CPB time

(mean) HRQOL Instruments Conclusion

Peri

operative

baseline

(n=46)

type

RCT Limited

Secondary outcomes:

haemodynamic performance, quality

of life (EQ-5D),

NYHA class

Safety outcomes: cardiac

reoperation, thromboembolism,

renal failure, paravalvular leak,

permanent pacemaker insertion,

resternotomy, major bleeding events,

endocarditis, myocardial infarction,

deep sternal wound infection,

assessment

Full

(n=48)

Pain scores similar

Blood loss less

cerebrovascular accident, respiratory

failure

Primary outcomes: respiratory

parameters

Secondary outcomes: bleeding,

transfusion,

pain status

Other reported outcomes:

intraoperative and postoperative

Peri

operative

assessment

(n=38)

Full

(n=39)

RCT Limited

blood loss, transfusion rates, CPB

and cross-clamp times, operation

time, mechanical ventilation time,

ICU stay, hospital stay, systemic

inammatory response syndrome,

re-exploration for bleeding, death,

spirometry (1, 2, and 7days), pain

scores, cardiac output studies

Full

Table 10.3 (continued)

Author, year, Ref Intervention

Borger 2015 [53] Limited vs.

sternotomy

Limited vs.

Full

sternotomy

Calderon etal.

2009 [54]

10 The Impact ofValve Surgery ontheHealth-Related Quality ofLife ofElderly Patients: Systematic Review

Quality

score

Physical

component

improved

NA 12

ITU length of stay less

Pain scores similar

Blood loss less

Reduced AF NA 13

NA 13

ITU and total length of stay less

Blood loss less

Lung function better

Less post-op ventilation

No difference in hospital stay 9

201

Follow-up

duration

No. of

patients at

Study

Primary outcomes: operative time,

CPB and cross-clamp time,

postoperative ventilation,

24-h chest tube drainage,

ICU stay,

hospital stay

(mean) HRQOL Instruments Conclusion

Peri

operative

assessment

baseline

(n=20)

Full

(n=20)

type

RCT Limited

Limited vs.

Full

sternotomy

Author, year, Ref Intervention

Dogan etal. 2003

[55]

Secondary outcomes: spirometry

(postoperative day 6 or 7),

pain scores (days 2 to 3 and 6 to 7),

neuropsychological and biochemical

tests

reported outcomes:

cross-clamp time, CPB time,

operation time, postoperative

ejection fraction, duration of

ventilation,

Peri

operative

assessment

(n=60)

Full

(n=60)

RCT Limited

Limited vs.

Full

sternotomy

Machler etal.

1999 [56]

chest tube drainage at 24h,

reoperation requirements, pericardial

effusions, conversion to full

sternotomy, arrhythmias, strokes,

wound infection, sternal instability,

sternal pain

Reported outcomes: pulmonary

function tests (1week and 1month

post), length of incision, operating

time, CPB time, ventilation time,

chest drainage at 24hours,

Peri

operative

assessment

(n=30)

Full

(n=30)

RCT Limited

Limited vs

Full

sternotomy

Moustafa etal.

2007 [57]

blood transfusions, ICU stay,

total hospital stay, participant survey

of cosmetic effect, analgesia use

Hospital

RCT Limited

Limited vs.

Nair etal. 2018

stay

(n=118)

Full

sternotomy

[58]

(n=104)

202

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Quality

score

Physical component

improved

Similar improvement 14

affected physical

component negatively

Mid-term result scores

where similar

Mobility scores lower

than general population

MLHF scores related to

pre-operative conditions

MVr showed more

improvement

Physical improvement

similar

Y. S. Abdullahi et al.

QoL scores better after

robotic approach

MVr shows

improvement in QoL

however this is unlikely

with LV impairment

QoL determined by

co-morbidities

HRQOL

Instruments Conclusion

Follow-up

duration

(mean)

12months SF-12, MLHF No signicant difference was

No. of patients

at baseline

RCT MVr N=126

seen

MVR

N=125

6months SF-36 QoL may be better in MVr AF, female gender, MVR

MVR N=24

physical health, role function,

general health

MVR

prosthesis did not predict

MLHF scores

37months SF-36 MVr had better scores in

7years NHP QoL similar between MVr and

MVR N=62

MVR N=99

Retrospective N=225 2years MLHF MVr/MVR and choice of

physical and mental component

in MVr

MVr

MVr showed more in mental

component improvement

slightly improved scores in rst

18months SF-36 More improvement in both

MVR N=25

12months NYHA, SF-36 NHYA more improved after

MVR

24months DASI, SF-12 Robotic was associated with

N=104

N=72

Prospective Sternotomy

year

Robotic

N=69

improvement in QoL

Impaired LV function showed

3months SF-36 MVr showed better

MVR N=21

no improvement in QoL

aetiology of MR.QoL

determined by females and LV

function

MVr vs. MVR

(ischaemic)

Author, year,

Table 10.4 Trials and others studying mitral valve surgery and QoL

Reference Intervention Study type

Aker etal.

2014 [59]

MVr vs. MVR Prospective MVr N=32

Ay etal.

2013 [60]

MVr vs. MVR Retrospective MVr N=53

Immer etal.

2003 [61]

MVr vs. MVR Prospective MVr N=85

Jokinen etal.

MVr/MVR

2007 [36]

Maisano

(elderly)

MVr vs. MVR Prospective MVr N=45

etal. 2009

[23]

Sedrakyan

MVr vs. MVR Prospective MVr N=163

etal. 2006

[18]

Zhao etal.

MVr

(sternotomy vs.

robotic assisted)

MVr or MVR Retrospective MVr N=40

2007 [31]

Suri etal.

2007 [62]

Goldsmith

etal. 2001

MVr Retrospective N=663 4.1year NYHA, SF-36 QoL was comparable across

[22]

Hansen etal.

2010 [63]

10 The Impact ofValve Surgery ontheHealth-Related Quality ofLife ofElderly Patients: Systematic Review

203

Patient after MVr have

similar QoL to general

study group were similar to age

RAND-36 Health survey variables of

population

Complete ring may have

and gender adjusted general

population

Lower scores for patient

worse QoL

MVr in asymptomatic

patients resulted in

following ring

walk

showed comparable physical

excellent QoL

and mental components as

MVr with Geoform ring

established similar well

being matched general

population

compared to age and gender

matched population

No signicant difference was

seen in individual or composite

(mental or physical) scores

SF36

(compared to

general

population)

(FU=109)

MVr Retrospective N=130

Heikkinen

etal. 2005

[64]

4.3years SF-36, 6min

Ring N=42

Retrospective Band N=65

MVr (complete

Mesana etal.

Retrospective N=46 8.4years NYHA, SF-36 QoL (SF-36) assessment

ring vs. partial

band)

MVr

(asymptomatic)

2013 [65]

van Leeuwen

etal. 2013

50months NYHA

(FU=49)

MVr (ischaemic) Retrospective N=86

[66]

Timek etal.

2014 [67]

204

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Y. S. Abdullahi et al.

or intermediate frail according to the Phenotype Frailty score have been shown to correlate to have lower physical and mental quality of life scores [17] but a numerous body of evidence challenges this conclusion.

Studies presented age alone should not be a

precluding factor of worsening QoL post-surgery [5, 18, 19]. In fact, Sedrakyan etal. (2003) show that not only is age not correlated with QoL postsurgery, but that benets reaped from valvular surgery seem to be prominent regardless of age. Additionally, Lam and Hendry [20] found that in octogenarians undergoing aortic valve replacement, quality of life post-operatively was equivalent to, or better than their counterparts.

HRQOL Outcome: PCS vs. MCS

A signicant improvement in QoL following valve surgery was overwhelmingly reported regardless of the different QoL tools used, even for the studies that pre-selected baseline characteristics, or grouped patients into cohorts of middle and advanced age. Similarly articles that compared their study to country specic age matched population norms noted overall improvement in quality of life. However, majority of the articles 25 reported improvement in PCS and general health compared to 8 articles for marked improvement in MCS. Four studies reported MCS did not improve while Van Geldorp and Tseng added MCS score was lower than population norms and didn’t benet from surgery concurring with the study by Maliwa and colleagues.

Given that the overwhelming majority of lit-

erature indicated QoL is generally improved by surgical intervention, this study aimed to assess predictors of poor quality of life post valvular surgery.

Predictors ofQuality ofLife

Assessing predictors of QoL was a difcult task as data on the subject matter is extremely limited; in fact, more than half of the studies didn’t

evaluated any predictors of QoL post-surgery. The predictors identied in the studies are briey discussed below and summarised in Fig.10.2.

Female Gender

Goldsmith et al. (2001) reported female gender as an independent predictor of lower QoL following an open Mitral valve repair or replacement. This was previously reported in a large study of 741 patients that also included concomitant procedure with (212 MVP and MVR patients) by Flameng and colleagues [21]. The decline in general health for female gender in the rst 3months post-surgery is not yet well known.

Mitral Regurgitation

Studies [22, 23] investigated the impact of mitral regurgitation/residual following MR on the QoL.They noted non-signicant improvement in QoL 3 months post-surgery when compared to baseline data in both open MV repair and replacement, with patients presenting etiology of mitral regurgitation (MR) with end systolic dimensions of more than 45mm disadvantaged. Conversely patients with functional MR had improved their QoL post-surgery compared to those presenting degenerative MR in minimal invasive based MV repair.

Coronary Artery Disease

Four studies [11, 24–26] focused on the impact of coronary artery disease on the quality of life of patients undergoing aortic valve replacement. Studies reported previous myocardial infarction (MI) was predictive of rapid improvement in the physical component of QoL shortly after cardiac surgery. They however indicated non-signicant mental health component improvement regardless of patient’s history of coronary artery disease, acute MI, previous PCI intervention or repeat CABG surgery. Interestingly one study

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