Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses

OBJECTIVES We sought to determine whether the quality of life (QoL) is different in patients after aortic valve replacement with mechanical prostheses or pulmonary autografts. BACKGROUND Quality of life after mechanical valve replacement may be affected by the risk of thromboembolism and anticoagulation, and after autograft implantation, by the risk of degeneration and re-operation especially of the homograft. METHODS Two groups of 40 patients each—one after the autograft procedure (group I) and one after mechanical valve implantation (group II)—were matched for age, gender and length of follow-up. At latest follow-up, all patients underwent routine echocardiography, the short-form health survey (SF-36) QoL survey and an extensive psychological investigation. RESULTS Patients with an autograft showed better QoL scales, as compared with mechanical valve recipients. The difference was significant for both the physical (72.72 ± 20.00 vs. 60.27 ± 26.07, P = 0.021) and psychological health sum scores (74.71 ± 21.03 vs. 64.71 ± 23.49, P = 0.046) and for the subtests of physical functioning (73.72 ± 22.44 vs. 62.77 ± 25.42, P = 0.049), physical pain (88.39 ± 19.13 vs. 73.36 ± 27.08, p ≤ 0.006), general health perception (64.37 ± 17.88 vs. 51.86 ± 22.86, p ≤ 0.008) and health change (61.89 ± 18.94 vs. 50.11 ± 24.37, P = 0.02). The QoL variables did not correlate to pressure gradients, ejection fraction and New York Heart Association functional class. Psychometric tests revealed no meaningful differences between the groups. CONCLUSIONS This study provides some evidence that patients with pulmonary autografts have greater benefit in terms of QoL, as compared with recipients of mechanical valve substitutes.