Quality of life in aortic valve replacement: Pulmonary autografts versus mechanical prostheses

OBJECTIVES: We sought to determine whether the quality of life (QoL) is different in patients after aortic valve replacement with mechanical prostheses or pulmonary autografts. BACKGROUND: Quality of life after mechanical valve replacement may be affected by the risk of thrombo-embolism and anticoagulation, and after autograft implantation, by the risk of degeneration and re-operation especially of the homograft. METHODS: Two groups of 40 patients each - one after the autograft procedure (group I) and one after mechanical valve implantation (group II) - were matched for age, gender and length of follow-up. At latest follow-up, all patients underwent routine echocardiography, the short-form health survey (SF-36) QoL survey and an extensive psychological investigation. RESULTS: Patients with an autograft showed better QoL scales, as compared with mechanical valve recipients. The difference was significant for both the physical (72.72 ± 20.00 vs. 60.27 ± 26.07, p = 0.021) and psychological health sum scores (74.71 ± 21.03 vs. 64.71 ± 23.49, p = 0.046) and for the subtests of physical functioning (73.72 ± 22.44 vs. 62.77 ± 25.42, p = 0.049), physical pain (88.39 ± 19.13 vs. 73.36 ± 27.08, p ≤ 0.006), general health perception (64.37 ± 17.88 vs. 51.86 ± 22.86, p ≤ 0.008) and health change (61.89 ± 18.94 vs. 50.11 ± 24.37, p = 0.02). The QoL variables did not correlate to pressure gradients, ejection fraction and New York Heart Association functional class. Psychometric tests revealed no meaningful differences between the groups. CONCLUSIONS: This study provides some evidence that patients with pulmonary autografts have greater benefit in terms of QoL, as compared with recipients of mechanical valve substitutes.