Quality of Life and Anxiety in Younger Patients after Biological versus Mechanical Aortic Valve Replacement

Abstract

Background 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. The aim of this study is to compare the quality of life (QOL) and anxiety in patients who have undergone biological versus mechanical AVR.

Method A total of 56 patients after mechanical AVR (mean age: 64.4 ± 8.17 years) and 66 patients after biological AVR (mean age: 64.8 ± 11.05 years) received three questionnaires 5.66 (± 2.68) years after surgery, including: The short form-36 (SF-36) to assess QOL, 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 and valve and anticoagulation-specific questions.

Results No significant differences were found for all categories of the SF-36. The FOP showed significantly favorable values for the biological AVR group. The CAQ showed a tendency in the subscale “avoidance” (i.e., avoidance of pulse increase) and “attention” towards more favorable values for the biological AVR group.

Conclusions In contrast to our hypothesis, patients after mechanical AVR show significantly higher anxiety values for the FOP, and a tendency toward 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 reoperation in the future after biological AVR. We conclude that implantation of a biological prosthesis can be justified in younger patients with regards to QOL.

Keywords

aortic valve replacement - quality of life - cardiac anxiety - fear of progression

Note

A part of this article was presented as oral presentation at the 6th Joint Meeting of the Society for Heart Valve Disease and Heart Valve Society of America; June 25–28, 2011; Barcelona, Spain.³⁰

• References

• 1 Vahanian A, Alfieri O, Andreotti F , et al; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012; 42 (4) S1-S44
• 2 Bonow RO, Carabello BA, Chatterjee K , et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48 (3) e1-e148
• 3 Perchinsky M, Henderson C, Jamieson WR , et al. Quality of life in patients with bioprostheses and mechanical prostheses. Evaluation of cohorts of patients aged 51 to 65 years at implantation. Circulation 1998; 98 (19, Suppl): II81-II86 , discussion II86–II87
• 4 Stein PD, Alpert JS, Bussey HI, Dalen JE, Turpie AG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 2001; 119 (1, Suppl): 220S-227S
• 5 Koertke H, Hoffmann-Koch A, Boethig D , et al. Does the noise of mechanical heart valve prostheses affect quality of life as measured by the SF-36 questionnaire?. Eur J Cardiothorac Surg 2003; 24 (1) 52-57 , discussion 57–58
• 6 Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 2000; 36 (4) 1152-1158
• 7 Ikonomidis JS, Kratz JM, Crumbley III AJ , et al. Twenty-year experience with the St Jude Medical mechanical valve prosthesis. J Thorac Cardiovasc Surg 2003; 126 (6) 2022-2031
• 8 Bottio T, Rizzoli G, Caprili L, Testolin L, Thiene G, Gerosa G. Biological versus mechanical aortic prosthesis? A nineteen-year comparison in a propensity-matched population. J Heart Valve Dis 2005; 14 (4) 493-500
• 9 Sedrakyan A, Hebert P, Vaccarino V , et al. Quality of life after aortic valve replacement with tissue and mechanical implants. J Thorac Cardiovasc Surg 2004; 128 (2) 266-272
• 10 Vicchio M, Della Corte A, De Santo LS , et al. Tissue versus mechanical prostheses: quality of life in octogenarians. Ann Thorac Surg 2008; 85 (4) 1290-1295
• 11 Aboud A, Breuer M, Bossert T, Gummert JF. Quality of life after mechanical vs. biological aortic valve replacement. Asian Cardiovasc Thorac Ann 2009; 17 (1) 35-38
• 12 Akins CW, Miller DC, Turina MI , et al; STS; AATS; EACTS. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg 2008; 85 (4) 1490-1495
• 13 Smith HJ, Taylor R, Mitchell A. A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL. Heart 2000; 84 (4) 390-394
• 14 McHorney CA, Ware Jr JE, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32 (1) 40-66
• 15 Herschbach P, Berg P, Dankert A , et al. Fear of progression in chronic diseases: psychometric properties of the Fear of Progression Questionnaire. J Psychosom Res 2005; 58 (6) 505-511
• 16 Eifert GH, Thompson RN, Zvolensky MJ , et al. The cardiac anxiety questionnaire: development and preliminary validity. Behav Res Ther 2000; 38 (10) 1039-1053
• 17 Lancaster TR, Singer DE, Sheehan MA , et al; Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The impact of long-term warfarin therapy on quality of life. Evidence from a randomized trial. Arch Intern Med 1991; 151 (10) 1944-1949
• 18 Bech-Hanssen O, Caidahl K, Wall B, Mykén P, Larsson S, Wallentin I. Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis. J Thorac Cardiovasc Surg 1999; 118 (1) 57-65
• 19 Piazza N, Bleiziffer S, Brockmann G , et al. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 1). JACC Cardiovasc Interv 2011; 4 (7) 721-732
• 20 Hoyer J, Eifert GH, Einsle F , et al. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res 2008; 64 (3) 291-297
• 21 Blome-Eberwein SA, Mrowinski D, Hofmeister J, Hetzer R. Impact of mechanical heart valve prosthesis sound on patients' quality of life. Ann Thorac Surg 1996; 61 (2) 594-602
• 22 Limb D, Kay PH, Murday AJ. Problems associated with mechanical heart valve sounds. Eur J Cardiothorac Surg 1992; 6 (11) 618-620
• 23 Nishi K, Eishi K, Shibata Y , et al. Influence of prosthetic heart valve sound on a patient's quality of life. Ann Thorac Cardiovasc Surg 2010; 16 (6) 410-416
• 24 Aicher D, Holz A, Feldner S, Köllner V, Schäfers HJ. Quality of life after aortic valve surgery: replacement versus reconstruction. J Thorac Cardiovasc Surg 2011; 142 (2) e19-e24
• 25 Goldberg LR. The structure of phenotypic personality traits. Am Psychol 1993; 48 (1) 26-34
• 26 Sutin AR, Zonderman AB, Ferrucci L, Terracciano A. Personality traits and chronic disease: implications for adult personality development. J Gerontol B Psychol Sci Soc Sci 2013; 68 (6) 912-920
• 27 Samartzis L, Dimopoulos S, Manetos C , et al. Neuroticism personality trait is associated with Quality of Life in patients with Chronic Heart Failure. World J Cardiol 2014; 6 (10) 1113-1121
• 28 Costa P, McCrae R. Professional Manual for the Revised NEO Personality Inventory and NEO Five-Factor Inventory. Odessa, FL: Psychological Assessment Resources, Inc; 1992
• 29 Banbury MK, Cosgrove III DM, Thomas JD , et al. Hemodynamic stability during 17 years of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg 2002; 73 (5) 1460-1465