Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement

Background: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. Methods: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of<0.65 cm(2)/m(2) (19 patients), Group 2 had an iEOA between 0.65-0.85 cm(2)/m(2) (71 patients), and Group 3 had an iEOA of >0.85 cm(2)/m(2)). Mean EQ-5D-5L scores were compared among the groups statistically. Results: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 +/- 0.18, Group 2: 0.83 +/- 0.20, and Group 3: 0.86 +/- 0.9, p = 0.044 and p = 0.014). The EQ5D-5L score was significantly lower in patients with a >= 20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 +/- 0.25 vs. 0.84 +/- 0.18, p = 0.014). Conclusions: Our results show that an iEOA <0.65 cm(2)/m(2) is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.