Reachability of Improved Quality of Life after Cardiac Surgery as an Important Marker of Decision Making in Young and Elderly Patients

Objectives: Decisions for the procedure performed during cardiac surgery are driven by the baseline pathology and risk-score calculation. Patient’s anxiety often leads to denial of operations and favoritism of less invasive but may be minor durable options. We ask if cardiac surgery fulfils preoperative desire gains, quality and desire of life, and physical and emotional function.

Methods: We analyzed 250 all participants preoperatively regarding status and expectations of quality of life and lifetime from May 2016 to November 2016. We monitored operative course and outcome. In a 2-year long-term follow-up (2018), we analyzed physical and emotional function, markers of quality of life status, and changes in the attitude toward cardiac surgery operations. We used SF12 and AZH questionnaire. Analysis was performed for patients < 60 years, 60 to 75 years, and older 75 years.

Results: Patients were mainly male (58.8%), slightly overweight, and mean age was 68.6 years. Euroscore II was 2.8 ± 0.16. We performed CABG; mitral-, tricuspid-, aortic-valve open surgery; TAVI; and aortic surgery as single or combined operation.

Before surgery, patients exhibited a reduction of quality of life to 65% of best possible condition independent of age and were willing to invest up to one-third of lifetime for better quality of life. Female patients had lowest quality of life and higher NYHA classification, Euroscore, and STS score at baseline. Operative procedures and perioperative morbidity did not differ between groups. However, elderly and female patients underwent longer in hospital treatment. Mortality correlated to risk score calculation but was overall lower than expected. NYHA and CCS classes reduced significantly in all groups.

Overall quality of life improved 2 years after therapy, independent of age. Women stated significantly better improvement. Physical fitness improved, as well in younger, still employed patients as in older participants. Quality of life maintained to be of highest importance in all groups. Nonetheless, it was clearly proven that patients did not want to “invest” lifetime for further improvement of quality of life.

Conclusion: Preoperatively patients show high anxiety toward cardiac surgery and express the will to improve quality of life even for the cost of lifetime reduction. Even in elderly patients and high-risk procedures, open cardiac surgery can achieve improved quality of life, emotional function, and physical function and fulfil the patient’s wish. Decision making for therapeutic strategies should involve quality of life as a marker of open surgical procedures.