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J Thorac Cardiovasc Surg 2004;128:266-272
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Quality of life after aortic valve replacement with tissue and mechanical implants

^a Division of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn, USA
^b Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA
^c Department of Medicine, Division of Cardiology, Emory University School of Medicine, and Rollins School of Public Health, Atlanta, Ga, USA
^d Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn, USA
^e Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn, USA

This study was presented at the 3rd Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Oct 1, 2001, Washington, DC.

Received for publication September 25, 2003; revisions received December 10, 2003; accepted for publication December 15, 2003.

^* Address for reprints: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088, USA
harlan.krumholz{at}yale.edu

OBJECTIVES: We sought to determine whether changes in quality of life at 18 months following aortic valve replacement differ depending on the use of tissue valves or mechanical valves.

METHODS: We prospectively studied 73 patients with tissue valve replacements and 53 patients with mechanical valve replacements performed from April 1998 through March 1999 at Yale-New Haven Hospital. Quality of life was measured at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-Item Health Survey.

RESULTS: Baseline unadjusted mean quality-of-life scores were lower in tissue valve recipients than in mechanical valve recipients and, for both groups, were generally lower than US population norms. At 18 months postoperatively, quality-of-life scores were greatly improved in both groups and were comparable to population norms (ie, within one-half a standard deviation). After adjusting for baseline quality of life, age, and other prognostic factors in an analysis of covariance, improvements in quality-of-life scores for tissue valve recipients versus mechanical valve recipients were similar. Of 10 (8 domains and 2 summary) scales examined, the only significant difference between the 2 groups was for the improvement in role limitations due to physical problems (Role Physical), which was more favorable in patients with mechanical valve implants (P = .04).

CONCLUSIONS: The use of tissue valve implants versus mechanical valve implants has little influence on improvement in quality of life at 18 months following aortic valve replacement. Thus, decisions about whether to choose a tissue valve or mechanical valve implant should depend upon other factors such as rates of complications and differences in the life span of the implants.

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