Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Patient-reported outcomes after aortic valve surgery in non-elderly adults
T. Holst1, J. Petersen1, B. Waschki2, M. Rybczynski2, H. Reichenspurner1, E. Girdauskas3
1Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 3Klinik für Herz- & Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg;

Objectives: Although being increasingly considered crucial, subjective outcomes obtained by patient self-report have not been well evaluated in young patients undergoing aortic valve (AV) surgery. Hence, we aimed to compare patient-reported outcomes after AV repair vs conventional AV replacement (AVR) vs the Ross procedure in non-elderly adults during the first postoperative year. 


Methods:
 Patients scheduled for elective AV repair or Ross procedure at our institution were prospectively included in our study from October 2017 to August 2020. Patient-reported outcomes were assessed upon admission, at 3 months and at 1 year after surgery using standardized instruments (i.e., 12-Item Short Form Health Survey (SF-12), EuroQoL 5 Dimensions (EQ-5D), Time-Trade-Off (TTO), Hospital Anxiety and Depression Scale (HADS)). 


Results:
 A total of 100 patients (mean age: 44±13 years, 82 % male) were prospectively included: 55 patients underwent AV repair, 14 patients had the Ross procedure and in 31 patients conventional AVR was performed.

Significantly improved scores on all measures of patient-reported outcomes were detected in all three surgical categories at 1-year follow-up when compared to preoperatively. 

At 1 year postoperatively, scores of patients of all three groups were similar to published data on healthy individuals in terms of all measures, depression levels being even significantly lower in all our patients (AV repair vs reference value: 2.7±3.0 vs 4.4±0.0, p<0.001; AVR vs reference value: 2.9±3.3 vs 4.9±0.0, p=0.006; Ross vs reference value: 1.1±1.9 vs 4.0±0.0, p<0.001) and physical quality of life (QoL) assessed by the SF-12 being even significantly better at least in the Ross group (Ross vs reference value: 54±3 vs 52±1 %, p=0.030) as compared to the reference values.

Between-group comparison revealed a trend towards a lower anxiety level in Ross vs AV repair patients (3.6±2.2 vs 5.1±4.1, p=0.060) at 3 months postoperatively and a significantly lower depression level in Ross vs AV repair (1.1±1.9 vs 2.7±3.0, p=0.025) and Ross vs AVR patients (1.1±1.9 vs 2.9±3.3, p=0.044) at 1 year postoperatively. Moreover, Ross patients reported a higher general QoL measured by the EQ-5D at 1-year follow-up as compared to AVR patients (96±6 vs 88±13 %, p=0.023).


Conclusion:
 Significant improvement in patient-reported outcomes after AV surgery was found in all three surgical categories. Ross patients reported significantly lower depression and significantly higher general QoL at 1-year follow-up vs AV repair/AVR patients and were the only group showing a significantly higher physical QoL postoperatively as compared to healthy individuals. Our study thus underlines the value of the Ross procedure in today’s surgical armamentarium for treating aortic valve disease in non-elderly patients. 


https://dgk.org/kongress_programme/jt2022/aP1571.html