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Hamiko M, Jahnel K, Rogaczewski J, Schafigh M, Silaschi M, Spaeth A, Velten M, Roell W, Ahmad AES, Bakhtiary F. The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta. J Clin Med 2023; 12:4498. [PMID: 37445533 DOI: 10.3390/jcm12134498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Despite optimal surgical therapy, replacement of the ascending aorta leads to a significant reduction in the quality of life (QoL). However, an optimal result includes maintaining and improving the QoL. The aim of our study was to evaluate the long-term outcome and the QoL in patients with aneurysms in the ascending aorta; (2) Methods: Between 2014 and 2020, 121 consecutive patients who underwent replacement of the ascending aorta were included in this study. Acute aortic pathologies were excluded. A standard short form (SF)-36 questionnaire was sent to the 112 survivors. According to the surgical procedure, patients were divided into two groups (A: supracoronary replacement of the aorta, n = 35 and B: Wheat-, David- or Bentall-procedures, n = 86). The QoL was compared within these groups and to the normal population, including myocardial infarction (MI), coronary artery disease (CAD) and cancer (CAN) patients; (3) Results: 83 patients were males (68.6%) with a mean age of 62.0 ± 12.5 years. Early postoperative outcomes showed comparable results between groups A and B, with a higher re-thoracotomy rate in B (A: 0.0% vs. B: 22.1%, p = 0.002). The 30-day mortality was zero. Overall, mortality during the follow-up was 7.4%. The SF-36 showed a significant decay in both the Physical (PCS) and Mental Component Summary (MCS) in comparison to the normal population (PCS: 41.1 vs. 48.4, p < 0.001; MCS: 42.1 vs. 50.9, p < 0.001) but without significant difference between both groups. Compared to the MI and CAD patients, significantly higher PCS but lower MCS scores were detected (p < 0.05); (4) Conclusions: Replacement of the ascending aorta shows low risk regarding the operative and postoperative outcomes with satisfying long-term results in the QoL. The extent of the surgical procedure does not influence the postoperative QoL.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Katja Jahnel
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Julia Rogaczewski
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Myriam Schafigh
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Andre Spaeth
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Wilhelm Roell
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Tu J, Wang F, Yin F, Zhang L, Zhao B, Zhou J. The relationship between quality of life and health promotion behavior in patients with type B aortic dissection: a cross-sectional study. J Cardiothorac Surg 2023; 18:23. [PMID: 36639794 PMCID: PMC9838059 DOI: 10.1186/s13019-023-02124-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To understand the current situation of health promotion behavior and quality of life among aortic dissection survivors and the correlation between them. METHODS Sociodemographic characteristics were collected. T-test and variance analysis were applied for univariate analysis. Quality of life was measured using the SF-36 Questionnaire, and health-promoting behaviors were measured using the aortic dissection health promotion behavior questionnaire. The association between type B aortic dissection survivors' health promotion behavior and health status questionnaire (SF-36) scores was determined through Pearson's correlation coefficients. This association was analyzed through multivariable regression analysis. RESULTS A total of 131 type B aortic dissection survivors were evaluated through the self-developed aortic dissection patient health promotion behavior scale and health status questionnaire (SF-36). Results showed that the health promotion behavior of Stanford B aortic dissection survivors (85.05 ± 11.28) correlated with their Mental Component Summary (MCS) (55.23 ± 30.72; r = 0.359, P < 0.01). The model showed 39.00% variance shared between behavior motivation and MCS (R2 = 0.390, F = 13.189, P < 0.01). CONCLUSION Type B aortic dissection survivors in Zunyi, China had a lower quality of life. Medical staff can formulate intervention measures from behavioral motivation to improve the quality of life of aortic dissection survivors.
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Affiliation(s)
- Jianxin Tu
- grid.413390.c0000 0004 1757 6938Nursing Department, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China ,grid.417409.f0000 0001 0240 6969Nursing Department, Zunyi Medical University, Zunyi, China
| | - Fei Wang
- grid.417409.f0000 0001 0240 6969Nursing Department, Zunyi Medical University, Zunyi, China
| | - Furong Yin
- grid.417409.f0000 0001 0240 6969Nursing Department, Zunyi Medical University, Zunyi, China
| | - Linxue Zhang
- grid.417409.f0000 0001 0240 6969Nursing Department, Zunyi Medical University, Zunyi, China
| | - Benli Zhao
- grid.417409.f0000 0001 0240 6969Nursing Department, Zunyi Medical University, Zunyi, China
| | - Jiamei Zhou
- grid.413390.c0000 0004 1757 6938 Cardiovascular Surgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China ,grid.417409.f0000 0001 0240 6969Nursing Department, Zunyi Medical University, Zunyi, China ,grid.413390.c0000 0004 1757 6938 Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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The Analysis of the Relationship between the Quality of Life Level and Expectations of Patients with Cardiovascular Diseases under the Home Care of Primary Care Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063300. [PMID: 35328988 PMCID: PMC8949918 DOI: 10.3390/ijerph19063300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023]
Abstract
The World Health Organization defines quality of life as a person’s perception of his or her life situation in relation to the culture and value system in which he or she lives, in relation to and with respect to his or her functioning assumptions, expectations, and standards set by environmental conditions. Meeting the expectations of patients with CVD is one of the factors that positively influences their health status and leads to better diagnostic and treatment outcomes. The aim of this study was to answer three main questions related to patients with chronic cardiovascular disease: (1) What is their quality of life? (2) Are patients’ expectations about the quality of care provided by primary health care physicians/nurses met (and at what level)? (3) Is there a correlation between patients’ quality of life and their expectations of primary health care physicians/nurses? The study involved 193 Polish CVD patients who were cared for at home by a family nurse practitioner working in primary health care facilities. Data were collected from March 2016 to January 2017. The WHOQOL-BREF Quality of Life Questionnaire and the Author Interview Questionnaire were used for the study. Data analysis was based on the Spearman correlation coefficient test. There was a statistically significant association between patients’ expectations of the physician regarding information about the course of the disease and quality of life in the following domains: environmental r = 0.20, p = 0.006, psychological: r = 0.18, p = 0.015, physical: r = 0.18, p = 0.013, and social: r = 0.16, p = 0.025. Patients who did not expect the nurse to be courteous, understanding, or interested were found to have higher quality of life scores in psychological (r = −0.17, p = 0.023) and physical (r = −0.15, p = 0.044) domains. There was a statistically significant relationship between expectations of care from nurses regarding intimacy during care activities and the level of satisfaction with one’s own health (r = −0.15, p = 0.038) and quality of life (r = −0.14, p = 0.045), as well as quality of life in the domains of physical (r = 0.21, p = 0.004), social (r = 0.19, p = 0.010), and psychological (r = 0.16, p = 0.024). There is a need to define the expectations of patients with chronic cardiovascular disease in primary care, as lack of expectations of a physician/nurse continues to be associated with lower quality of life in all domains.
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Olsthoorn JR, Lam KY, Akca F, Timmermans NMAJ, Tan MESH. Sutureless aortic valve with supracoronary ascending aortic replacement as an alternative strategy for composite graft replacement in elderly patients. Neth Heart J 2021; 30:125-130. [PMID: 34283394 PMCID: PMC8881536 DOI: 10.1007/s12471-021-01594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Aortic valve disease is frequently associated with ascending aorta dilatation and can be treated either by separate replacement of the aortic valve and ascending aorta or by a composite valve graft. The type of surgery is depending on the exact location of the aortic dilatation and the concomitant valvular procedures required. The evidence for elective aortic surgery in elderly high-risk patients remains challenging and therefore alternative strategies could be warranted. We propose an alternative strategy for the treatment of ascending aortic aneurysm and aortic valve pathology with the use of a sutureless, collapsible, stent-mounted aortic valve prosthesis.
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Affiliation(s)
- J R Olsthoorn
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - K Y Lam
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - F Akca
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - N M A J Timmermans
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - M E S H Tan
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Bi Y, Yi M, Han X, Ren J. Clinical outcomes and quality of life in patients with acute and subacute type B aortic dissection after thoracic endovascular aortic repair. J Int Med Res 2020; 48:300060520945506. [PMID: 32776820 PMCID: PMC7418244 DOI: 10.1177/0300060520945506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Thoracic endovascular aortic repair (TEVAR) is considered the mini-invasive treatment of choice for patients with Stanford type B aortic dissection (TBAD). This study aimed to investigate the clinical outcomes and quality of life (QoL) in patients with acute and subacute TBAD after TEVAR. Methods From January 2014 until July 2016, 22 acute patients (Group A) and 18 subacute patients received TEVAR (Group B), and 13 patients were managed non-operatively (Group C). The Medical Outcomes Study Short Form-36 was used to assess QoL preoperatively and after TEVAR. Operative techniques and complications were retrospectively analyzed. Results The role emotion, vitality, and mental health domains scored well preoperatively. Except for role emotion, vitality, and mental health, the remaining domains significantly improved after TEVAR. There was no significant difference in QoL metrics between Groups A and B. In Group C, bodily pain and social functioning domains were improved, and role emotion was decreased, with no improvement in the remaining domains. The 3-year survival rates were 95.5%, 100%, and 85.7% for Groups A, B, and C, respectively. Conclusions TEVAR may be safe and effective in patients with acute and subacute TBAD with similar and favorable clinical and QoL metrics.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengfei Yi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Gökalp AL, de Heer F, Etnel JRG, Kluin J, Takkenberg JJM. Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old. Ann Cardiothorac Surg 2019; 8:372-382. [PMID: 31240181 DOI: 10.21037/acs.2019.04.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selecting the optimal surgical treatment strategy in patients below the age of 65 years (i.e., non-elderly patients) with aortic valve or aortic root disease remains challenging. The objective of the current study is to summarize contemporary research on clinical and quality of life outcomes after aortic valve replacement (AVR) and aortic root surgery in non-elderly patients. Recent systematic reviews on clinical outcome after biological and mechanical AVR, the Ross procedure and aortic root surgery show that event occurrence is considerable after any type of AVR or aortic root surgery and-with the exception of the Ross procedure-survival is suboptimal. Although thromboembolism and bleeding events are more common after mechanical AVR and root surgery, these events are also considerably present after biological AVR, the Ross procedure and valve-sparing aortic root surgery (VSRR). Similarly, reoperation is more common after biological AVR, the Ross procedure and VSRR, but also occurs frequently after mechanical AVR and root replacement. Published evidence in AVR patients points to the direction of better health-related quality of life (HRQoL) outcomes with a biological solutions, while the HRQoL after aortic root surgery is limited and contradictory. This review illustrates that treatment for non-elderly aortic valve and aortic root disease patients needs to be tailored to the individual patient, considering both clinical and HRQoL outcomes as crucial factors to reach a treatment decision that best reflects the patient's values and goals in life.
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Affiliation(s)
- Arjen L Gökalp
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jolanda Kluin
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Gökalp AL, Takkenberg JJ. Decision-Making in Thoracic Aortic Aneurysm Surgery—Clinician and Patient View. Semin Thorac Cardiovasc Surg 2019; 31:638-642. [DOI: 10.1053/j.semtcvs.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/12/2019] [Indexed: 01/16/2023]
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de Heer F, Gökalp AL, Kluin J, Takkenberg JJM. Measuring what matters to the patient: health related quality of life after aortic valve and thoracic aortic surgery. Gen Thorac Cardiovasc Surg 2019; 67:37-43. [PMID: 28905303 PMCID: PMC6323078 DOI: 10.1007/s11748-017-0830-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/03/2017] [Indexed: 01/22/2023]
Abstract
With improved outcomes following cardiac surgery, health related quality of life (HRQoL) gains increasing importance for the better judgement of choosing the preferred treatment strategy in the individual patient. The physician perception of patient preferences can differ considerably from actual patient preferences, underlining the importance of gathering evidence of actual patient preferences before and quality of life after cardiac surgery. The objective of the current review is to provide an overview of current insights into the quality of life measurements after aortic valve and thoracic aortic surgery and to provide starting points for the application of HRQoL measurements toward the future. The amount and level of evidence on HRQoL outcomes after aortic valve and thoracic aortic surgery seems to be insufficient. Little has been investigated about the natural course of HRQoL after cardiac surgery, HRQoL outcomes between different surgical strategies, HRQoL outcomes between surgical patients and the general population, the different factors influencing HRQoL after cardiac surgery, and the effect of HRQoL on healthcare costs. More prospective studies should be performed, taking into account the knowledge gaps that need to be filled. Computerized adaptive testing methods through open source programs can be implemented to keep the burden to the patient as low as possible and catalyze the use of these tools. Our cardiovascular surgery community has the responsibility to deliberate how it can proceed to effectively fill in these knowledge gaps, and use this newfound knowledge to improve shared treatment decision making, patient outcomes, and ultimately optimize health care efficiency.
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Affiliation(s)
- Frederiek de Heer
- Dept. of Cardio-Thoracic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Arjen L Gökalp
- Dept. of Cardio-Thoracic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Jolanda Kluin
- Dept. of Cardio-Thoracic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Johanna J M Takkenberg
- Dept. of Cardio-Thoracic Surgery, Bd563, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Suárez Bagnasco M, Núñez-Gil IJ. Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects. World J Cardiol 2017; 9:620-628. [PMID: 28824792 PMCID: PMC5545146 DOI: 10.4330/wjc.v9.i7.620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/16/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To summarize the current evidence on psychological issues in thoracic aortic disease (TAD) and infective endocarditis (IE) setting.
METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, PubMed and PsycINFO, we searched full manuscripts in English and published until September 1, 2014.
RESULTS We found sixteen studies exploring psychological issues in patients with IE (six studies) and in TAD (ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE (four papers) and in TAD (eight papers). Depression and anxiety were analyzed in TAD only (five papers). Post-traumatic stress disorder was assessed in IE (one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ.
CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
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Jarral OA, Kidher E, Patel VM, Nguyen B, Pepper J, Athanasiou T. Quality of life after intervention on the thoracic aorta. Eur J Cardiothorac Surg 2015; 49:369-89. [DOI: 10.1093/ejcts/ezv119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
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Olsson C, Franco-Cereceda A. Health-Related Quality of Life in Thoracic Aortic Disease: Part II. After Surgery on the Proximal (Root, Ascending, Arch) Aorta. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:162-70. [PMID: 26798689 DOI: 10.12945/j.aorta.2013.13-029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/12/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) has been reported to be near-to-normal after operations on the proximal aorta. However, a thorough evaluation of variables related to postoperative HRQOL is lacking. We report HRQOL after surgery on the proximal aorta acknowledging current symptoms and conditions. If modifiable factors affect HRQOL, surgical treatment could be tailored to optimize outcomes. METHODS The short form 36 item (SF-36) questionnaire was used to measure HRQOL in eight domains and a physical component summary (PCS) and mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures, along with comparisons of patient subgroups according to pathology (aneurysm versus dissection), aortic valve procedure, and circulatory arrest. RESULTS In 207 patients operated on the proximal aorta, after a mean of three years, there were no significant differences in median PCS (Δ = -0.3 [95% confidence limits -2.6, 2.0]) and MCS (Δ = 1.7 [-0.4, 2.9]) scores compared to the reference group, but median scores for the physical functioning, general health, and mental health domains were significantly lower. There were no statistically significant differences in PCS, MCS, or domain scores for patients with aneurysm versus dissection, for patients undergoing aortic valve procedures or not, or for patients managed with circulatory arrest or not. In multivariable analysis, exertional dyspnea was independently related to both ΔPCS (-6.5 [-13, -0.44]) and ΔMCS (-7.5 [-13, -1.6]), whereas age, exertional calf pain, and myocardial infarction were related only to ΔPCS. CONCLUSIONS Overall HRQOL after surgery on the proximal aorta is encouraging, which remains important when benchmarking against novel therapeutic procedures. At follow-up, HRQOL appears related to current symptoms and conditions, but not to operative procedures. To better understand their impact on HRQOL, prospective studies comparing pre- and postoperative scores are needed.
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Affiliation(s)
- Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Lehr EJ, Wang PZT, Oreopoulos A, Kanji H, Norris C, Macarthur R. Midterm outcomes and quality of life of aortic root replacement: mechanical vs biological conduits. Can J Cardiol 2011; 27:262.e15-20. [PMID: 21459276 DOI: 10.1016/j.cjca.2010.12.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/05/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Aortic root replacement is a complex operation for severe aortic root pathology such as aneurysms and dissections with concomitant aortic valve disease. Biological and mechanical valve conduits are available. METHODS Early and midterm results were analyzed in patients undergoing aortic root replacement. From January 1, 1998, to May 31, 2007, 144 patients underwent aortic root replacement (Bentall procedures) with either a mechanical (n = 51) or a biological (n = 93) valve conduit. Cox proportional hazard analysis was used to determine whether valve type was an independent predictor of all-cause mortality, and analysis of covariance was used to compare general and disease-specific health-related quality-of-life scores. RESULTS Operative mortality was 2.1%. Median follow-up time was 40 months; 1- and 5-year survival rates for the mechanical group were 96.0% and 89.0%, respectively, vs 93.0% and 84.0% for the biological group. Valve type was not predictive of all-cause mortality, and valve-related complications were not significantly different between groups. At follow-up, 31.5% of patients in the biological group were on anticoagulant. General and disease-specific health-related quality-of-life scores were not significantly different between groups. CONCLUSIONS Aortic root replacement with either mechanical or biological valved conduits is a safe procedure. Morbidity, mortality, and adverse quality of life were not associated with the type of valve conduit. Further studies are required to assess long-term durability of biological valve conduits used for aortic root replacement.
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Affiliation(s)
- Eric J Lehr
- The University of Maryland School of Medicine, Baltimore, MD, USA
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Carrel T, Schoenhoff FS, Eckstein F, Schmidli J. Reply to the Editor. J Thorac Cardiovasc Surg 2009. [DOI: 10.1016/j.jtcvs.2008.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakahira A, Shibata T, Sasaki Y, Hirai H, Hattori K, Hosono M, Ehara S, Suehiro S. Outcome after the modified Bentall technique with a long interposed graft to the left coronary artery. Ann Thorac Surg 2009; 87:109-15. [PMID: 19101281 DOI: 10.1016/j.athoracsur.2008.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The modified Bentall technique, which was reported by Svensson in 1992, is an aortic root composite valve graft replacement involving reimplantation of the left coronary ostium with a long interposed graft wrapping behind the composite graft. The technique is technically advantageous, particularly for complicated or redo aortic roots. To justify the technique, the midterm outcome needs to be evaluated. METHODS Since 1992, 40 patients (4 with Marfan syndrome) underwent the modified Bentall technique (Svensson's modification). The mean age was 54.7 +/- 13.6 years, and 32 patients (80.0%) were male. All hospital survivors have been consecutively followed with annual echocardiographic evaluations. Furthermore, in 2007, multislice computed tomography was performed at 4.7 +/- 3.5 years (maximum, 14.9 years) postoperatively in 30 patients who had preserved renal function. RESULTS No patients have experienced any complications regarding the technique at the follow-up of 5.7 +/- 4.0 years (maximum, 14.9 years), although there were 2 hospital deaths of emergency cases and 5 late deaths owing to noncardiac causes. In 35 patients (92.1% of hospital survivors), no structural complications were detected by multislice computed tomographies of the 30 patients or coronary angiograms of the remaining 5 patients. The consecutive echocardiographic follow-ups showed well-preserved left ventricular function with the most recent ejection fraction being 0.581 +/- 0.078. CONCLUSIONS This Svensson's modification technique was associated with favorable midterm outcomes by multislice computed tomography and consecutive echocardiographic evaluations, indicating long-lasting advantages as well as technical benefits. Thus, the technique can be considered as a helpful and justifiable alternative method.
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Affiliation(s)
- Atsushi Nakahira
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
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