Impact of Valve Type (Ross vs. Mechanical) on Health-Related Quality of Life in Children and Young Adults with Surgical Aortic Valve Replacement.
Congenital heart disease
Mechanical aortic valve replacement
Quality of life
Ross procedure
Surgical aortic valve replacement
Journal
Pediatric cardiology
ISSN: 1432-1971
Titre abrégé: Pediatr Cardiol
Pays: United States
ID NLM: 8003849
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
20
08
2020
accepted:
18
12
2020
pubmed:
8
4
2021
medline:
25
6
2021
entrez:
7
4
2021
Statut:
ppublish
Résumé
The impact of aortic valve replacement (AVR) type on health-related quality of life (HRQOL) in adolescents and young adults is unclear, but may vary depending on need for anticoagulation or re-intervention. We sought to determine the differences in HRQOL following AVR with either the Ross procedure or mechanical AVR in this young population. Patients 14-35 years old and at least 1 year post-AVR were included. HRQOL was assessed using the Short Form-36 (SF-36). Valve-specific concerns regarding anticoagulation and reoperation were also assessed. Clinical outcome data were obtained by chart review. A total of 51 patients were enrolled: 24 (47%) Ross and 27 (53%) mechanical AVR. Ross patients were younger at time of AVR (16 vs. 22 years, p < 0.01) and study enrollment (23.7 vs 29.5 years, p < 0.01). Median follow-up from AVR to study enrollment was similar (5.4 years for Ross vs. 5.6 years for mechanical, p = 0.62). At last follow-up, clinical outcomes including cardiac function, functional class, and aortic valve re-intervention rates were similar between groups, although mechanical valve patients had more bleeding events (p = 0.012). SF-36 scores were generally high for the entire cohort, with no significant difference between groups in any domain. Mechanical AVR patients reported more concern about frequency of blood draws (p < 0.01). Concern for reoperation was similar between both groups. Despite more bleeding events and concern about the frequency of blood draws, adolescents and young adults with mechanical AVR reported similarly high levels of HRQOL compared to those following Ross AVR.
Sections du résumé
BACKGROUND
BACKGROUND
The impact of aortic valve replacement (AVR) type on health-related quality of life (HRQOL) in adolescents and young adults is unclear, but may vary depending on need for anticoagulation or re-intervention. We sought to determine the differences in HRQOL following AVR with either the Ross procedure or mechanical AVR in this young population.
METHODS
METHODS
Patients 14-35 years old and at least 1 year post-AVR were included. HRQOL was assessed using the Short Form-36 (SF-36). Valve-specific concerns regarding anticoagulation and reoperation were also assessed. Clinical outcome data were obtained by chart review.
RESULTS
RESULTS
A total of 51 patients were enrolled: 24 (47%) Ross and 27 (53%) mechanical AVR. Ross patients were younger at time of AVR (16 vs. 22 years, p < 0.01) and study enrollment (23.7 vs 29.5 years, p < 0.01). Median follow-up from AVR to study enrollment was similar (5.4 years for Ross vs. 5.6 years for mechanical, p = 0.62). At last follow-up, clinical outcomes including cardiac function, functional class, and aortic valve re-intervention rates were similar between groups, although mechanical valve patients had more bleeding events (p = 0.012). SF-36 scores were generally high for the entire cohort, with no significant difference between groups in any domain. Mechanical AVR patients reported more concern about frequency of blood draws (p < 0.01). Concern for reoperation was similar between both groups.
CONCLUSION
CONCLUSIONS
Despite more bleeding events and concern about the frequency of blood draws, adolescents and young adults with mechanical AVR reported similarly high levels of HRQOL compared to those following Ross AVR.
Identifiants
pubmed: 33825913
doi: 10.1007/s00246-021-02589-y
pii: 10.1007/s00246-021-02589-y
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1119-1125Références
Nelson JS, Maul TM, Wearden PD et al (2019) National practice patterns and early outcomes of aortic valve replacement in children and teens. Ann Thorac Surg 108:544–551. https://doi.org/10.1016/j.athoracsur.2019.03.098
doi: 10.1016/j.athoracsur.2019.03.098
pubmed: 31075247
Etnel JRG, Elmont LC, Ertekin E et al (2016) Outcome after aortic valve replacement in children: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 151:143-152.e3. https://doi.org/10.1016/j.jtcvs.2015.09.083
doi: 10.1016/j.jtcvs.2015.09.083
pubmed: 26541831
Nötzold A, Hüppe M, Schmidtke C et al (2001) Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses. J Am Coll Cardiol 37:1963–1966. https://doi.org/10.1016/S0735-1097(01)01267-0
doi: 10.1016/S0735-1097(01)01267-0
pubmed: 11401139
Aicher D, Holz A, Feldner S et al (2011) Quality of life after aortic valve surgery: replacement versus reconstruction. J Thorac Cardiovasc Surg 142:e19–e24. https://doi.org/10.1016/j.jtcvs.2011.02.006
doi: 10.1016/j.jtcvs.2011.02.006
pubmed: 21450311
Zacek P, Holubec T, Vobornik M et al (2016) Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study. BMC Cardiovasc Disord. https://doi.org/10.1186/s12872-016-0236-0
doi: 10.1186/s12872-016-0236-0
pubmed: 27039180
pmcid: 4818911
Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36) I. Conceptual framework and item selection. Med Care 30:473–483
doi: 10.1097/00005650-199206000-00002
Idorn L, Jensen AS, Juul K et al (2013) Quality of life and cognitive function in Fontan patients, a population-based study. Int J Cardiol 168:3230–3235. https://doi.org/10.1016/j.ijcard.2013.04.008
doi: 10.1016/j.ijcard.2013.04.008
pubmed: 23632112
Müller J, Hess J, Hager A (2013) General anxiety of adolescents and adults with congenital heart disease is comparable with that in healthy controls. Int J Cardiol 165:142–145. https://doi.org/10.1016/j.ijcard.2011.08.005
doi: 10.1016/j.ijcard.2011.08.005
pubmed: 21872351
Perchinsky M, Henderson C, Jamieson WRE et al (1998) Quality of life in patients with bioprostheses and mechanical prostheses: evaluation of cohorts of patients aged 51 to 65 years at implantation. Circulation 98:81II-86II
Jones S, Monagle P, Manias E et al (2013) Quality of life assessment in children commencing home INR self-testing. Thromb Res 132:37–43. https://doi.org/10.1016/j.thromres.2013.05.011
doi: 10.1016/j.thromres.2013.05.011
pubmed: 23726963
Bauman ME, Massicotte MP, Kuhle S et al (2015) EMPoWARed: Edmonton pediatric warfarin self-management study. Thromb Res 136:887–893. https://doi.org/10.1016/j.thromres.2015.08.026
doi: 10.1016/j.thromres.2015.08.026
pubmed: 26362472
Amedro P, Bajolle F, Bertet H et al (2018) Quality of life in children participating in a non-selective INR self-monitoring VKA-education programme. Arch Cardiovasc Dis 111:180–188. https://doi.org/10.1016/j.acvd.2017.05.013
doi: 10.1016/j.acvd.2017.05.013
pubmed: 29100908
Körtke H, Körfer R (2001) International normalized ratio self-management after mechanical heart valve replacement: is an early start advantageous? Ann Thorac Surg 72:44–48. https://doi.org/10.1016/S0003-4975(01)02656-X
doi: 10.1016/S0003-4975(01)02656-X
pubmed: 11465228
Sidhu P, O’Kane HO (2001) Self-managed anticoagulation: results from a two-year prospective randomized trial with heart valve patients. Ann Thorac Surg 72:1523–1527. https://doi.org/10.1016/S0003-4975(01)03049-1
doi: 10.1016/S0003-4975(01)03049-1
pubmed: 11722037
Menéndez-Jándula B, Souto JC, Oliver A et al (2005) Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med 142:1. https://doi.org/10.7326/0003-4819-142-1-200501040-00006
doi: 10.7326/0003-4819-142-1-200501040-00006
pubmed: 15630104
Siebenhofer A, Rakovac I, Kleespies C et al (2007) Self-management of oral anticoagulation in the elderly: rationale, design, baselines and oral anticoagulation control after one year of follow-up: a randomized controlled trial. Thromb Haemost 97:408–416. https://doi.org/10.1160/TH06-08-0482
doi: 10.1160/TH06-08-0482
pubmed: 17334508
Beyth RJ (2000) A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin: a randomized controlled trial. Ann Intern Med 133:687. https://doi.org/10.7326/0003-4819-133-9-200011070-00010
doi: 10.7326/0003-4819-133-9-200011070-00010
pubmed: 11074901
Matchar DB, Jacobson A, Dolor R et al (2010) Effect of home testing of international normalized ratio on clinical events. N Engl J Med 363:1608–1620. https://doi.org/10.1056/NEJMoa1002617
doi: 10.1056/NEJMoa1002617
pubmed: 20961244
Sawicki PT (1999) A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. JAMA 281:145. https://doi.org/10.1001/jama.281.2.145
doi: 10.1001/jama.281.2.145
pubmed: 9917117
Etnel JRG, Helbing WA, Roos-Hesselink JW et al (2018) Patient and physician view on patient information and decision-making in congenital aortic and pulmonary valve surgery. Open Heart 5:e000872. https://doi.org/10.1136/openhrt-2018-000872
doi: 10.1136/openhrt-2018-000872
pubmed: 30487977
pmcid: 6242011
Wang Q, Hay M, Clarke D, Menahem S (2014) Associations between knowledge of disease, depression and anxiety, social support, sense of coherence and optimism with health-related quality of life in an ambulatory sample of adolescents with heart disease. Cardiol Young 24:126–133. https://doi.org/10.1017/S1047951113000012
doi: 10.1017/S1047951113000012
pubmed: 23402427