title: Health-related quality of life following isolated aortic valve surgery: is earlier intervention better?
abstract: OBJECTIVE
  The study aim was to determine the health-related quality of life (HRQL) in conjunction with clinical outcomes following aortic valve replacement (AVR) surgery. In these times of healthcare change, quality measures of the success of a procedure go beyond clinical outcomes, with patient reports of HRQL considered important.
  
  
  METHODS
  All patients who had undergone AVR surgery were followed prospectively through the authors' valve registry and the local Society of Thoracic Surgery (STS) database. The HRQL (Short-Form 12 and Minnesota Living with Heart Failure Questionnaire) was collected preoperatively, and at six and 12 months after surgery.
  
  
  RESULTS
  Since 2005, a total of 459 patients have undergone isolated AVR surgery. The mean age, ejection fraction and STS risk score were 65.8 +/- 13.6 years, 57.7 +/- 11.0%, and 2.8 +/- 3.5 (range: 0.4-47.9), respectively. The median (IQR) length of hospital stay was 5 (3-7) days. Compared to the STS national norms, all clinical outcomes were excellent. A Kaplan-Meier analysis showed the two year cumulative survival as 92.0%. After 12 months the physical and mental HRQL had improved significantly, surpassing age and heart disease norms (p < 0.001 and p = 0.02, respectively). Multivariate analysis determined that a higher 12-month physical HRQL was predicted by a lower STS risk score (B = -1.3, p < 0.001) and a lower perioperative morbidity (B = -5.5, p = 0.02) after adjustment for baseline HRQL, age, and gender. In a subset of patients classified as 'symptomatic', as determined by higher MLHF scores, the HRQL scores were increased to age norms and surpassed the heart disease norms.
  
  
  CONCLUSIONS
  Patients who undergo AVR can expect excellent clinical and HRQL outcomes, with greater benefits the earlier the surgery is carried out. The tracking of HRQL is valuable in understanding the success of a procedure from the patients' perspective.
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, VA 22042, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Speir
authors.forename: Linda L
authors.initials: LL
authors.lastname: Henry
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hunt
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D057186:Comparative Effectiveness Research; D061345:Early Medical Intervention; D005260:Female; D006334:Heart Function Tests / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011446:Prospective Studies; D058996:Quality Improvement; D011788:Quality of Life; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology