Impact of Choice of Prosthetic Heart Valves on Quality of Life for Elderly Patients after Mitral Valve Replacement：A Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Tiefu , WANG Shengyu , ZHOU Qiwen , LIU Dong , MA Hanying.

1. Department of Cardiovascular Surgery，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，P. R . China;;
2. Department of Geriatric Cardiology，Beijing Anzhen hospital，Capital Medical University，Beijing 100029，P. R . China;

Corresponding author：

Keywords：

Geriatrics; 　Mitral valve replacement; 　Biological heart valve; 　Quality of life

DOI：

10.7507/1007-4848.20130132

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Objective To evaluate postoperative quality of life （QOL） of patients aged over 65 after mitral valvereplacement （MVR）. Methods Ninety patients aged over 65 undergoing MVR by the same surgical group in Departmentof Cardiovascular Surgery of Anzhen Hospital were prospectively enrolled in this study. There were 62 male and 28 femalepatients with their age of 65-76 （68.6±6.8） years. There were 55 patients with hypertension，38 patients with type 2 diabetes，and all the patients had persistent atrial fibrillation. Nottingham Healthy Profile （NHP，Part I） and Duke Activity StatuIndex （DASI） were used to evaluate preoperative and postoperative QOL. According to the choice of prosthetic heart valves they received，all the patients were divided into two groups with 45 patients in each group: biological valve group and mechanical valve group. All the patients received MVR via the interatrial groove approach under general anesthesia and cardiopulmonary bypass. Mechanical valve replacement was performed using continuous suture without preserving the posterior leaflet of the mitral valve. Biological valve replacement was performed using interrupted suture and some of the posteriorleaflet of the mitral valve was routinely preserved. Patients in both groups underwent intraoperative bilateral pulmonary vein isolation and left atrial appendage ablation using a bipolar radiofrequency ablation device. The left atrial appendage was not excised or ligated. Results Postoperative QOL of all the patients was significantly better than preoperative QOL. There was no statistical difference in NHP and DASI at the 6th month after discharge between the 2 groups. But from the 1st year after discharge，QOL of the biological valve group was significantly better than that of the mechanical valve group. At the 3rd year after discharge，NHP and DASI of the mechanical valve group was not statistically different from those at the 1st year after discharge，but NHP and DASI of the biological valve group was significantly better than those at the 1st year after discharge. Conclusions QOL of elderly patients are significantly improved after MVR. Patients who receive biologicalvalve replacement may acquire better long-term QOL than patients who receive mechanical valve replacement.

Citation： ZHAO Tiefu,WANG Shengyu,ZHOU Qiwen,LIU Dong,MA Hanying.. Impact of Choice of Prosthetic Heart Valves on Quality of Life for Elderly Patients after Mitral Valve Replacement：A Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 430-434. doi: 10.7507/1007-4848.20130132 Copy

1.	Herlitz J， Brandrup-Wognsen G， Caidahl K， et al. Determinants for an impaired quality of life 10 years after coronary artery bypass surgery. Int J Cardiol， 2005， 98 （3）：447-452.
2.	Pinheiro EM， Lopes P. Quality of life 2 years after coronary revascularization. Enferm Clin， 2007， 17：309-317.
3.	Hlatky MA， Boineau RE， Higginbotham MB， et al. A brief self-administered questionnaire to determine functional capacity （The Duke Activity Status Index）. Am J Cardiol， 1989， 64 （10）：651-654.
4.	李颖，孙凤. 依那普利治疗对原发性高血压患者生活质量的影响. 中华老年心脑血管病杂志， 2003， 5 （4）：236.
5.	龙浩，郑燕，林勇斌，等. 电视胸腔镜与小切口开胸治疗临床早期非小细胞肺癌患者术后生活质量的前瞻性随机对照研究. 中国胸心血管外科临床杂志， 2012， 19 （2）：130-135. 6 颜涛，徐志云. SF-36量表评估心脏瓣膜病患者术后生活质量的研究进展. 中国胸心血管外科临床杂志， 2012， 19 （4）：419-422.
6.	穆军升，周帆，张健群，等. 80岁以上老年患者冠状动脉旁路移植术65例临床分析. 中国胸心血管外科临床杂志， 2011， 18 （5）：464-465.
7.	马琛明，陈彧，解基严，等. 老年冠心病患者在冠状动脉旁路移植术后生命质量的研究. 中华老年心脑血管病杂志， 2008， 10 （8）：585-587.
8.	赵铁夫，王盛宇，周其文，等. 70岁及以上患者非体外冠状动脉旁路移植术后生活质量的研究. 中华老年医学杂志， 2010， 29 （10）：818-820.
9.	David TE， Armstrong S， Maganti M. HancockⅡbioprosthesis for aortic valve replacement：the gold standard of bioprosthetic valves durability? Ann Thorac Surg， 2010， 90 （3）：775-781.
10.	彭勇，郭应强，张尔永. 牛心包生物瓣膜的临床应用. 中国胸心血管外科临床杂志， 2007， 14 （2）：144-146.
11.	Gao G， Wu Y， Grunkemeier GL， et al. Durability of pericardial versus porcine aortic valves. J Am Coll Cardiol， 2004， 44 （2）：384-388.
12.	Stassano P， Di Tommaso L， Monaco M， et al. Aortic valve replacement：a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. J Am Coll Cardiol， 2009， 54 （20）：1862-1868.
13.	Koertke H， Minami K， Boethig D， et al. INR self-management permits lower anticoagulation levels after mechanical heart valvereplacement. Circulation， 2003， 108 （Suppl 1）：II75-II78.
14.	Salem DN， O’gara PT， Madias C， et al. Valvular and structural heart disease：American College of Chest Physicians Evidence-Based Clinical Practice Guidelines （8th Edition） . Chest， 2008， 133 （6 Suppl）：593S-629S.
15.	Marenchino RG， Nikisch LE， Diodato LH， et al. Mid-term followupof patients submitted to aortic valve replacement with mechanical prosthesis. Rev Argent Cardiol， 2008， 76 （3）：187-192.
16.	李彤，蔡振杰，刘维永，等. 生物瓣心瓣膜置换术后远期疗效. 中国胸心血管外科临床杂志， 2006， 13 （3）：197-198.
17.	董力，石应康，黄旭中，等. 心脏机械瓣膜置换术后的远期疗效. 中国胸心血管外科临床杂志， 2003， 125 （6）：1420-1425.
18.	Archbold RA， Curzen NP. Off-pump coronary artery bypass graft surgery：the incidence of post operative atrial fibrillation. Heart， 2003， 89 （10）：1134-1137.
19.	Creswell LL， Alexander JC Jr， Ferguson TB Jr， et al. Intraoperativeinterventions：American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillationafter cardiac surgery. Chest， 2005， 128 （2 Suppl）：28S-35S.
20.	Bradley D， Creswell LL， Hogue CW Jr， et al. Pharmacologic prophylaxis：American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillationafter cardiac surgery. Chest， 2005， 128 （2 Suppl）：39S-47S.
21.	Zebis LR， Christensen TD， Thomsen HF， et al. Practical regimen for amiodarone use in preventing postoperative atrial fibrillation. Ann Thorac Surg， 2007， 83 （4）：1326-1331.
22.	Lee SH， Chang CM， Lu MJ， et al. Intravenou samiodarone for prevention of aftial fibrillation after coronary artery bypass grafting. Ann Thorac Surg， 2000， 70 （1）：157-161.
23.	Lee SH， Chang CM， Lu MJ， et al. Intravenou samiodarone for prevention of aftial fibrillation after coronary artery bypass grafting. Ann Thorac Surg， 2000， 70 （1）：157-161.

1. 　Herlitz J， Brandrup-Wognsen G， Caidahl K， et al. Determinants for an impaired quality of life 10 years after coronary artery bypass surgery. Int J Cardiol， 2005， 98 （3）：447-452.
2. 　Pinheiro EM， Lopes P. Quality of life 2 years after coronary revascularization. Enferm Clin， 2007， 17：309-317.
3. 　Hlatky MA， Boineau RE， Higginbotham MB， et al. A brief self-administered questionnaire to determine functional capacity （The Duke Activity Status Index）. Am J Cardiol， 1989， 64 （10）：651-654.
4. 　李颖，孙凤. 依那普利治疗对原发性高血压患者生活质量的影响. 中华老年心脑血管病杂志， 2003， 5 （4）：236.
5. 　龙浩，郑燕，林勇斌，等. 电视胸腔镜与小切口开胸治疗临床早期非小细胞肺癌患者术后生活质量的前瞻性随机对照研究. 中国胸心血管外科临床杂志， 2012， 19 （2）：130-135. 6 颜涛，徐志云. SF-36量表评估心脏瓣膜病患者术后生活质量的研究进展. 中国胸心血管外科临床杂志， 2012， 19 （4）：419-422.
6. 　穆军升，周帆，张健群，等. 80岁以上老年患者冠状动脉旁路移植术65例临床分析. 中国胸心血管外科临床杂志， 2011， 18 （5）：464-465.
7. 　马琛明，陈彧，解基严，等. 老年冠心病患者在冠状动脉旁路移植术后生命质量的研究. 中华老年心脑血管病杂志， 2008， 10 （8）：585-587.
8. 　赵铁夫，王盛宇，周其文，等. 70岁及以上患者非体外冠状动脉旁路移植术后生活质量的研究. 中华老年医学杂志， 2010， 29 （10）：818-820.
9. 　David TE， Armstrong S， Maganti M. HancockⅡbioprosthesis for aortic valve replacement：the gold standard of bioprosthetic valves durability? Ann Thorac Surg， 2010， 90 （3）：775-781.
10. 　彭勇，郭应强，张尔永. 牛心包生物瓣膜的临床应用. 中国胸心血管外科临床杂志， 2007， 14 （2）：144-146.
11. 　Gao G， Wu Y， Grunkemeier GL， et al. Durability of pericardial versus porcine aortic valves. J Am Coll Cardiol， 2004， 44 （2）：384-388.
12. 　Stassano P， Di Tommaso L， Monaco M， et al. Aortic valve replacement：a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. J Am Coll Cardiol， 2009， 54 （20）：1862-1868.
13. Koertke H， Minami K， Boethig D， et al. INR self-management permits lower anticoagulation levels after mechanical heart valvereplacement. Circulation， 2003， 108 （Suppl 1）：II75-II78.
14. 　Salem DN， O’gara PT， Madias C， et al. Valvular and structural heart disease：American College of Chest Physicians Evidence-Based Clinical Practice Guidelines （8th Edition） . Chest， 2008， 133 （6 Suppl）：593S-629S.
15. 　Marenchino RG， Nikisch LE， Diodato LH， et al. Mid-term followupof patients submitted to aortic valve replacement with mechanical prosthesis. Rev Argent Cardiol， 2008， 76 （3）：187-192.
16. 　李彤，蔡振杰，刘维永，等. 生物瓣心瓣膜置换术后远期疗效. 中国胸心血管外科临床杂志， 2006， 13 （3）：197-198.
17. 　董力，石应康，黄旭中，等. 心脏机械瓣膜置换术后的远期疗效. 中国胸心血管外科临床杂志， 2003， 125 （6）：1420-1425.
18. 　Archbold RA， Curzen NP. Off-pump coronary artery bypass graft surgery：the incidence of post operative atrial fibrillation. Heart， 2003， 89 （10）：1134-1137.
19. 　Creswell LL， Alexander JC Jr， Ferguson TB Jr， et al. Intraoperativeinterventions：American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillationafter cardiac surgery. Chest， 2005， 128 （2 Suppl）：28S-35S.
20. 　Bradley D， Creswell LL， Hogue CW Jr， et al. Pharmacologic prophylaxis：American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillationafter cardiac surgery. Chest， 2005， 128 （2 Suppl）：39S-47S.
21. 　Zebis LR， Christensen TD， Thomsen HF， et al. Practical regimen for amiodarone use in preventing postoperative atrial fibrillation. Ann Thorac Surg， 2007， 83 （4）：1326-1331.
22. 　Lee SH， Chang CM， Lu MJ， et al. Intravenou samiodarone for prevention of aftial fibrillation after coronary artery bypass grafting. Ann Thorac Surg， 2000， 70 （1）：157-161.
23. 　Lee SH， Chang CM， Lu MJ， et al. Intravenou samiodarone for prevention of aftial fibrillation after coronary artery bypass grafting. Ann Thorac Surg， 2000， 70 （1）：157-161.

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Impact of Choice of Prosthetic Heart Valves on Quality of Life for Elderly Patients after Mitral Valve Replacement：A Controlled Trial

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