Evaluation of quality of life in elderly patients moving surgical correction of aortal valve stenosis

Abstract

Aim. Conduct a comparative analysis of the patient's quality of life in the long-term period after surgical correction of aortic valve stenosis after undergoing transcatheter aortic valve replacement with the results of patients undergoing aortic valve replacement with a seamless biological prosthesis under artificial blood circulation. Materials and methods. A comprehensive examination and dynamic observation in the middle and late postoperative period for 251 patients of the older age group with aortic stenosis was performed. The average age of patients at the time of treatment was 67.62±9.94 years. Group 1 included 128 patients who underwent transcatheter aortic valve replacement. In turn, Group 1 is divided into two subgroups. Subgroup A consisted of 56 patients, due to the severity of the underlying disease, concomitant pathology EuroSCORE II more than 20% and STS SCORE more than 10%. Subgroup B consisted of 72 patients with a risk of outcome of EuroSCORE II surgical intervention less than 20% and STS SCORE less than 10%. Group 2 patients (n=123) were comparable to subgroup B by the severity of the underlying disease EuroSCORE II less than 20% and STS SCORE less than 10%. All patients in group II underwent aortic valve replacement under artificial circulation.To assess the quality of life, the SF-36 questionnaire was used 12, 24, 36, 48 and 60 months after surgery. Results. The greatest increase in the total total score in the postoperative period was noted in subgroup A - 3 times (p=0.000001), and in subgroups B and group 2 was 2.66 times (p=0.0000011). By the end of the observation period, the highest total score was recorded in subgroup B, in subgroup A it was lower by 3% (p=0.95), in group 2 - by 2.4% (p=0.97). A correlation is established between the average degree between the total score, reflecting the quality of life of patients after aortic valve replacement, and the rate of ejection fraction (R=0.23, p=0.034), and the left ventricular myocardium mass (R=-0.25, p=0.028) and shock volume (R=0.29, p=0.021) according to echocardiography. Conclusions. Thus, despite a number of difficulties that were observed after surgical correction of aortic stenosis in patients of the older age group, including the presence of concomitant somatic pathology, marked cardiac changes according to echocardiography, the analysis of quality of life indicators demonstrates the positive effect of surgical treatment with a significant improvement in quality of life.