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Quality of life after heart valve surgery with prolonged intensive care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
2005 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 80, no 5, 1693-1698 p.Article in journal (Refereed) Published
Abstract [en]

ACKGROUND:

A small proportion of patients undergoing heart valve operations require prolonged intensive care after surgery. Little is known about the quality of life that such patients attain after hospital discharge.

METHODS:

All consecutive patients who underwent primary heart valve surgery from 1998 to 2003 and required 8 days or more of treatment in an intensive care unit (ICU) were included (n = 225). At follow-up on August 31, 2004, 154 of these patients were alive. A cohort (n = 154) matched for sex, age, type of procedure, and week of operation, with an uncomplicated postoperative course (ICU stay of 2 days or less), served as the control group. All patients received the Medical Outcomes Study Short-Form 36, the Nottingham Health Profile, and the Hospital Depression and Anxiety scale to evaluate their quality of life.

RESULTS:

Survival at 5 years in the total ICU group was 68% (154 of 225). According to SF-36, the ICU study cohort reported poorer physical health but equal mental health compared with controls. On the Nottingham Health Profile, the ICU group reported more problems in all domains except emotional reactions and sleep. There was no difference in anxiety or depression between the groups. The ICU patients were in more advanced New York Heart Association functional classes preoperatively and postoperatively. No patient in the ICU study cohort regretted undergoing the operation, and 80% experienced improvement after surgery.

CONCLUSIONS:

This study showed reduced quality of life in terms of physical health and equal mental health in patients who required prolonged intensive care after heart valve surgery compared with controls without complications.

Place, publisher, year, edition, pages
2005. Vol. 80, no 5, 1693-1698 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93468DOI: 10.1016/j.athoracsur.2005.04.042PubMedID: 16242440OAI: oai:DiVA.org:uu-93468DiVA: diva2:166949
Available from: 2005-09-15 Created: 2005-09-15 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Heart Valve Surgery: Preoperative Assessment and Clinical Outcome
Open this publication in new window or tab >>Heart Valve Surgery: Preoperative Assessment and Clinical Outcome
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A more global analysis of the outcome of heart valve surgery is desirable to reflect the actual benefit for the patient. This thesis focuses on the preoperative assessment of the patient, and the outcome after surgery with regard to operative mortality, long-term survival, valve-related complications, and quality of life.

Magnetic resonance imaging and echocardiography were comparable in assessing severe mitral regurgitation, but did not agree in measuring regurgitant fraction. Natriuretic peptides correlated well to regurgitant fraction on magnetic resonance imaging and to PISA and vena contracta on echocardiography.

The risk of death, myocardial injury and postoperative heart failure after valve surgery has decreased over the last decade whereas the proportion older patients has increased.

Survival is reduced after mitral valve replacement in patients with severe symptoms whereas patients with less symptoms have excellent survival. Older patients are more often severly symptomatic at the time of mitral valve surgery.

Event-free survival is superior in patients with a mechanical prosthesis, but not influenced by valve type in older patients. A mechanical prosthesis is associated with a higher risk of bleeding < 5 years from surgery, especially in older patients; and a bioprosthesis is associated with a higher risk of thromboembolism > 5 years from surgery. Ageing with a mechanical prosthesis implied an increased risk for an adverse event, this was not true for bioprostheses.

Quality of life after complicated heart valve surgery resulted in reduced physical health but equal mental health compared to uncomplicated controls.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 69
Keyword
Surgery, Heart valve surgery, magentic resonance imaging, echocardiography, operative mortality, survival, complications, quality of life, Kirurgi
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-5929 (URN)91-554-6336-3 (ISBN)
Public defence
2005-10-06, Robergsalen, Ing.40, Akademiska Sjukhuset, 751 85 Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-09-15 Created: 2005-09-15 Last updated: 2013-09-13Bibliographically approved

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