Assessment of quality of life in patients after combined mitral and aortic valve replacement depending on the presence of coronary artery disease

Abstract

The  aim – to assess and compare quality of life (QoL) 12 months after combined mitral and aortic valve replacement according to the presence of coronary artery disease (CAD) and the extent of surgical intervention.
Materials and methods. A single-center combined prospective and retrospective study (2019–2023) included 157 adult patients who underwent mitral and aortic valve replacement. Patients were allocated to three groups: Group 1 (n = 57) – double-valve replacement + concomitant coronary artery bypass grafting (CABG); Group 2 (n = 50) – double-valve replacement with angiographically confirmed CAD but without concomitant CABG; Group 3 (n = 50) – double-valve replacement without CAD. QoL was assessed at 12 months using the SF-36 questionnaire. Multivariable linear regression was performed to identify independent predictors of reduced physical functioning (PF) and mental health (MH).
Results. In-hospital mortality was the highest in the concomitant CABG group (10.5 %) compared with Group 2 (2.0 %) and Group 3 (0 %) (p < 0.05). At 12 months, SF-36 scores demonstrated a graded relationship with surgical extent: the lowest QoL values were observed in Group 1, intermediate in Group 2, and the highest in Group 3 (p < 0.01–0.001). Physical functioning was 42.5 ± 6.4 in Group 1 versus 58.2 ± 5.8 in Group 2 and 64.5 ± 5.2 in Group 3 (p < 0.001). In multivariable analysis, CABG (β = –0.39; p = 0.002), age (β = –0.28; p = 0.010), and NYHA class III–IV (β = –0.33; p = 0.004) were independent predictors of reduced PF, whereas CAD without CABG was not independently associated with PF impairment (p = 0.11). For MH, CABG (β = –0.36; p = 0.004) and NYHA class III–IV (β = –0.29; p = 0.012) were independent predictors.
Conclusions. QoL at 12 months after combined mitral and aortic valve replacement is strongly dependent on the extent of surgery. The poorest QoL profile is associated with concomitant CABG, while CAD per se (without CABG) is not an independent determinant of reduced QoL. These findings support tailored postoperative rehabilitation and psychological support for patients undergoing double-valve replacement with CABG.