Maliwa M A, van der Heijden G J M G, Bots M L, van Hout B A, Casselman F P, van Swieten H, Vermeulen F E E
Department of Cardio-Thoracic Surgery and Stichting Hartenzorg, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Cardiovasc Surg. 2003 Oct;11(5):381-7. doi: 10.1016/S0967-2109(03)00030-9.
(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.
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.
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.
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.
（1）评估机械主动脉瓣置换术（mAVR）后长期存活者的生活质量（QoL）评分，采用SF36和欧洲生活质量量表（EQ - 5D）进行评估；（2）研究生活质量与纽约心脏协会（NYHA）心功能分级、严重出血和血栓栓塞事件数量以及随访时间之间的关联；（3）比较mAVR长期存活者的生活质量评分与其他人群的生活质量评分。
1964年至1974年间，共有312例患者在荷兰新韦根圣安东尼医院接受了mAVR手术。手术时的平均年龄为41岁（标准差 = 12）。1年随访时的术后平均NYHA心功能分级为1.7（标准差 = 0.7）。2001年，对存活者（n = 78；25%）进行晚期事件、NYHA心功能分级和生活质量评分的随访。69例患者（93%）返回了完整的问卷。
平均随访时间为30年（标准差 = 1.8）。应答者的平均年龄为65岁（标准差 = 10，范围47 - 93岁）。2001年，应答者的NYHA心功能分级为2级（标准差 = 0.9）。应答者的SF36平均（标准差）评分为：身体功能64（29）、身体角色功能64（29）、身体疼痛80（30）、总体健康55（25）、活力63（23）、社会功能73（29）、情感角色功能70（38）、心理健康76（18）。应答者的EQ - 5D平均评分为：61（13）。这些SF36和EQ - 5D评分与其他人群（如癌症、2型糖尿病、偏头痛、慢性肝病和髂动脉闭塞性疾病以及荷兰普通人群）的评分相当。对于应答者，发现SF36和EQ - 5D评分与其NYHA评分之间存在中度至高度关联（R2 = 0.36）。严重出血事件的数量、年龄、性别和生存时间与生活质量无关。
在接受mAVR手术患者的长期随访（平均30年）中，生活质量相对较高；与他们的NYHA心功能分级呈中度至高度相关；在长期随访中，出血和血栓栓塞事件似乎对生活质量影响不大。mAVR患者长期随访的生活质量与其他短期随访的横断面设计研究及其他人群相当。
