Quality of life after mitral valve surgery: Results from the Cardiothoracic Surgical Trials Network.

OBJECTIVE

To understand patterns and patient factors associated with health status recovery after mitral valve surgery.

METHODS

Patient-level data from 3 multicenter randomized trials of mitral valve surgery were harmonized, with heart failure-specific health status assessed with the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) Score. Linear mixed-effects models were used to describe health status over time and to explore patient factors associated with health status recovery.

RESULTS

The cohort included 807 patients undergoing mitral valve surgery (mean age 67.1 ± 10 years; 29.9% women); repair in 629 (77.9%) and replacement in 178 (22.1%). Before surgery, mean KCCQ-OS scores were 64.8 ± 22.9. There was little change in health status 1 month after surgery but large improvements by 6 months (+18.5 points, 95% CI, 16.9 to 20.2) that was sustained through 2 years. There were differences in recovery trajectories by baseline KCCQ-OS categories; patients with baseline KCCQ-OS ≥75 reported initial worsening at 1 month with recovery by 6 months, whereas patients with baseline KCCQ-OS <50 had large improvements even at 1 month. In the multivariable model, patients with lower baseline KCCQ-OS had significant improvements 2 years after surgery (3.4-point greater improvement, 95% CI, 1.7 to 5.1, for every 5-point lower baseline KCCQ-OS). Patients with prior stroke or transient ischemic attack and those with chronic lung disease had less KCCQ-OS improvements (mean change, -5.6 points; 95% CI, -11.2 to -0.1; -7.4 points; 95% CI, -13.5 to -1.4, respectively), with a trend toward less improvement in women (mean change, -3.2; 95% CI, -6.5 to 0.2).

CONCLUSIONS

Disease-specific health status improves significantly by 6 months after mitral valve surgery and is sustained through 2 years, with the greatest improvement in symptoms, function, and quality of life reported by those with worse health status before surgery. These results allow for more informed preoperative discussions with individualized estimations of the symptomatic benefit from surgery.