QUALITY-OF-LIFE IN PATIENTS WITH BIOPROSTHESES AND MECHANICAL PROSTHESES - EVALUATION OF COHORTS OF PATIENTS AGED 51 TO 65 YEARS AT IMPLANTATION

Background-The purpose of this study was 3-fold: to compare the qualit y of life (QOL) in age- and sex-matched patients who received biologic al and mechanical prosthetic valves in isolated aortic valve replaceme nt, to compare the QOL of patients with aortic valve replacement with the general population, and to compare patients with biological and me chanical prostheses with certain valve-specific questions and relate t hese responses to overall QOL. Methods and Results-Patient-perceived Q OL was evaluated in 200 patients who were sampled from a population of 420 patients (age range 51 to 65 years) who underwent isolated aortic valve replacement in the period of 1986 to 1996, One hundred of the s ampled patients had a mechanical valve inserted and an equal number ha d porcine bioprostheses. Three survey instruments were used to examine perceived QOL: the SF-12 form, a 7-valve specific question form, and the Lamy Smiley Faces form. The response to the questionnaires was 89. 5% (179 patients). Patients with mechanical valves were more bothered by valve sounds (P<0.01) and had a negative correlation (P<0.01) betwe en valve sound and QOL on the mental scale only. Patients with biologi cal valves were more fearful of the need for reoperation (P<0.01), but there was no correlation between fear and QOL, The mechanical valve g roup had a negative correlation (P<0.01) between fear of reoperation a nd QOL on both the mental and physical scales. There was no difference between the 2 cohorts with respect to fear of valve failure. Patients with mechanical valves were more concerned about frequency of medical visits and blood tests (P<0.01) as well as the possibility of anticoa gulant-related bleeding events (P<0.01). QOL was equivalent between th e 2 groups and to the general population for the same age group. Ninet y-seven percent of the patients indicated they would make the same sur gical decision again with regard to valve replacement; there was no di fference between the 2 valve groups on this question. Conclusions-Pati ent-perceived QOL is similar between patients with aortic mechanical a nd biological valve replacement in the studied age group and comparabl e to the general population of similar age. Although certain valve-spe cific differences exist between the 2 prosthetic types, these differen ces do not appear to affect overall QOL as described by these patients .