Patient-Reported Outcomes after Aortic Valve Surgery in Nonelderly Patients

Objectives: Subjective outcomes after aortic valve (AV) surgery obtained by patient self-report have not been well evaluated, especially in young patient cohorts. Thus, we aimed to analyze differences in patient-reported outcomes (PROs) after different types of AV surgery in non-elderly adults during the first postoperative year.

Methods: Patients scheduled for elective AV repair or Ross procedure were prospectively included in our study from October 2017 to August 2020. Assessment of PROs using standardized instruments (12-Item Short Form Health Survey (SF-12), EuroQoL 5 Dimensions (EQ-5D), Time-Trade-Off, Hospital Anxiety and Depression Scale) was performed on admission, at 3 months and at 1 year after surgery.

Result: A total of 100 patients (mean age: 44 ± 13 years, 82% male) were prospectively included: 55 underwent AV repair, 14 underwent Ross procedure, and 31 patients had aortic valve replacement (AVR).

Comparison between baseline and 1-year follow-up (FU) showed a significant increase in EQ-5D visual analogue scale (VAS) in AV repair (p < 0.001), AVR (p = 0.004), and Ross (p = 0.034) groups. Significant improvement in the cumulative EQ-5D sum score was found in the Ross group only (p = 0.005). Between-group comparison revealed significant baseline differences in EQ-5D VAS in AV repair versus Ross (71 ± 16% vs. 60 ± 20%, p = 0.028) and AV repair versus AVR (71 ± 16% vs. 63 ± 19%, p = 0.037). At 1-year FU, Ross patients reached a similar EQ-5D VAS level to AV repair patients (83 ± 12% vs. 84 ± 11%, p = 0.922) while AVR patients tended to remain at a lower level (76 ± 16% vs. 84 ± 11%, p = 0.076), indicating better improvement in the Ross group. Anxiety level decreased significantly from baseline to 3-months FU in all groups (AV repair and AVR: p < 0.001, Ross: p = 0.002) while depression level decreased in AV repair (p = 0.002) and AVR patients (p = 0.043). Between-group comparison revealed a significantly lower anxiety level in Ross versus AV repair (3.2 ± 2.1 vs. 5.1 ± 4.0, p = 0.036) and significantly lower depression level in Ross versus AVR (1.6 ± 1.6 vs. 4.0 ± 3.7, p = 0.012) during postoperative follow-up. Comparison of all PROs at 1-year FU to published healthy norms showed no significant differences.

Conclusion: Significant improvement in PROs after AV surgery was found in all three surgical categories. Ross patients demonstrated significantly lower anxiety and depression scores during follow-up versus AV repair/AVR patients and were the only group with a significantly improved cumulative EQ-5D sum score postoperatively.

Publication History

Article published online:
19 February 2021