Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.
Interact Cardiovasc Thorac Surg. 2021 Jul 26;33(2):210-217. doi: 10.1093/icvts/ivab069.
Our goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR).
We surveyed 113 patients who were operated on for AVR at 60-70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Decisional conflict was defined as the post hoc uncertainty perceived by patients regarding their choice of prosthesis.
The survey was performed at a median of 5.2 (3.2-8.1) years after the AVR. Patients with a biological valve were older (BIO: 68.4 years [66.2-69.4] vs MECH: 63.9 [61.9-66.7]; P < 0.001). Global post hoc satisfaction with prosthesis choice was high in both groups (MECH: 95.9%; BIO: 100%), and 85.1% (MECH) and 92.3% (BIO) of them would repeat their choice. Conflict about their decision was equal (MECH: 30.3%; BIO: 32.6%) for different reasons: MECH patients experienced more anticoagulation-related inconvenience (25.9% vs 0%), fear of bleeding (31.1% vs 0%) and prosthesis noise (26.2% vs 0%), whereas more BIO patients feared prosthesis failure (39.7% vs 17.4%) or reoperation (43.5% vs 18.1%). Active involvement in the decision (odds ratio 0.37, 95% confidence interval 0.16-0.85; P = 0.029) and adequate information about the prosthesis (odds ratio 0.34, 95% confidence interval 0.14-0.86; P = 0.020) decreased the risk of conflict about the decision.
Although 30% of the responders showed a decisional conflict related to prosthesis-specific interferences, global patient satisfaction with the prosthesis choice for AVR is excellent. Increasing the patient's involvement in the prosthesis choice through shared accountability and improved information is recommended to decrease the choice-related uncertainty.
本研究旨在探讨主动脉瓣置换术（AVR）后患者对人工心脏瓣膜的满意度和决策过程。
我们调查了 113 名年龄在 60-70 岁之间接受 AVR 手术的患者，其中 74 例患者使用机械瓣膜（MECH），39 例使用生物瓣膜（BIO）。本研究重点关注与假体选择和瓣膜相关并发症相关的生活质量和决策途径。决策冲突被定义为患者对假体选择的事后不确定性。
AVR 后中位随访时间为 5.2 年（3.2-8.1 年）。生物瓣患者年龄较大（BIO：68.4 岁[66.2-69.4] vs MECH：63.9 岁[61.9-66.7]；P<0.001）。两组患者对假体选择的总体术后满意度均较高（MECH：95.9%；BIO：100%），85.1%（MECH）和 92.3%（BIO）的患者会重复他们的选择。由于不同的原因，两组之间的决策冲突程度相当（MECH：30.3%；BIO：32.6%）：MECH 患者经历了更多与抗凝相关的不便（25.9%比 0%）、出血恐惧（31.1%比 0%）和人工心脏瓣膜噪音（26.2%比 0%），而更多的 BIO 患者担心人工心脏瓣膜失效（39.7%比 17.4%）或再次手术（43.5%比 18.1%）。积极参与决策（比值比 0.37，95%置信区间 0.16-0.85；P=0.029）和充分了解假体（比值比 0.34，95%置信区间 0.14-0.86；P=0.020）降低了决策冲突的风险。
尽管 30%的受访者表示对假体特异性干扰存在决策冲突，但患者对 AVR 人工心脏瓣膜选择的总体满意度非常高。通过共同承担责任和提供更多信息，增加患者对假体选择的参与度，有助于降低选择相关的不确定性。
