Health-Related Quality of Life in Thoracic Aortic Disease: Part II. After Surgery on the Proximal (Root, Ascending, Arch) Aorta

Abstract

BACKGROUND: Health-related quality of life (HRQOL) has been reported to be near-to-normal after operations on the proximal aorta. However, a thorough evaluation of variables related to postoperative HRQOL is lacking. We report HRQOL after surgery on the proximal aorta acknowledging current symptoms and conditions. If modifiable factors affect HRQOL, surgical treatment could be tailored to optimize outcomes. METHODS: The short form 36 item (SF-36) questionnaire was used to measure HRQOL in eight domains and a physical component summary (PCS) and mental component summary (MCS) score. Median differences (Delta) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures, along with comparisons of patient subgroups according to pathology (aneurysm versus dissection), aortic valve procedure, and circulatory arrest. RESULTS: In 207 patients operated on the proximal aorta, after a mean of three years, there were no significant differences in median PCS (Delta = -0.3 [95% confidence limits -2.6, 2.0]) and MCS (Delta = 1.7 [-0.4, 2.9]) scores compared to the reference group, but median scores for the physical functioning, general health, and mental health domains were significantly lower. There were no statistically significant differences in PCS, MCS, or domain scores for patients with aneurysm versus dissection, for patients undergoing aortic valve procedures or not, or for patients managed with circulatory arrest or not. In multivariable analysis, exertional dyspnea was independently related to both DeltaPCS (-6.5 [-13, -0.44]) and DeltaMCS (-7.5 [-13, -1.6]), whereas age, exertional calf pain, and myocardial infarction were related only to DeltaPCS. CONCLUSIONS: Overall HRQOL after surgery on the proximal aorta is encouraging, which remains important when benchmarking against novel therapeutic procedures. At follow-up, HRQOL appears related to current symptoms and conditions, but not to operative procedures. To better understand their impact on HRQOL, prospective studies comparing pre- and postoperative scores are needed.