title: Quality of life and NYHA class 30 years after mechanical aortic valve replacement.
abstract: OBJECTIVE
  (1) To evaluate the quality of life (QoL) scores, assessed with SF36 and EuroQol (EQ-5D), of long term survivors after mechanical aortic valve replacement (mAVR); (2) to study the association of QoL with NYHA score, number of major bleeding and thrombo-embolic events and follow-up time; (3) to compare QoL scores of long term mAVR survivors with QoL scores of other populations.
  
  
  METHODS
  In total 312 patients had a mAVR between 1964 and 1974 at St. Antonius Hospital Nieuwegein (NL). Mean age at operation was 41 (sd=12). Mean postoperative NYHA class at 1-year follow-up was 1.7 (sd=0.7). In 2001 the survivors (n=78; 25%) were followed-up for late events, NYHA class and QoL scores. 69 patients (93%) returned completed questionnaires.
  
  
  RESULTS
  Mean duration of follow-up was 30 years (sd=1.8). Mean age of responders was 65 years (sd=10, range 47-93). In 2001, NYHA class of responders was 2 (sd=0.9). The mean (sd) SF36 scores for responders were: 64 (29) for physical function, 64 (29) for role-physical, 80 (30) for bodily pain, 55 (25) for general health, 63 (23) for vitality, 73 (29) for social functioning, 70 (38) for role-emotional, 76 (18) for mental health. The mean EQ-5D score of responders was: 61 (13). These SF36 and EQ-5D scores are comparable to those of other populations (e.g. cancer, diabetes type-2, migraine, chronic liver disease and iliac artery occlusive disease and Dutch general population). For responders a moderate to high association of SF36 and EQ-5D scores and their NYHA scores (R2=0.36) was found. The number of major bleeding events, age, sex and survival time were not related to QoL.
  
  
  CONCLUSIONS
  At long term follow-up (mean 30 years) of patients who had mAVR, QoL was relatively high; it was moderately to highly associated with their NYHA class; bleeding and thromboembolic events seem to be of little importance for the QoL at long term follow-up. QoL at long term follow-up of patients who had mAVR is comparable to other cross sectional designed studies with short term follow-up and other population.
authors.affiliation: Department of Cardio-Thoracic Surgery and Stichting Hartenzorg, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands. mamaliwa@ision.nl
authors.forename: M A
authors.initials: MA
authors.lastname: Maliwa
authors.forename: G J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: B A
authors.initials: BA
authors.lastname: van Hout
authors.forename: F P
authors.initials: FP
authors.lastname: Casselman
authors.forename: H
authors.initials: H
authors.lastname: van Swieten
authors.forename: F E E
authors.initials: FE
authors.lastname: Vermeulen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D019918:Heart Valve Prosthesis Implantation / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D011788:Quality of Life; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome