RESUMO
BACKGROUND: French laypeople's views on xenotransplantation were examined. METHODS: A convenience sample of 224 adults (among them, 37 nurses) judged of the acceptability of xenotransplantation in 50 realistic scenarios composed of various combinations of 4 factors: 1. the type of graft (eg, pig cardiac valve), 2. the level of urgency (eg, critical condition with very high risk of death in the short term), 3. the patient's or the family's level of consent (eg, the members of the family are divided on the issue), and 4. whether the transplantation was temporary or definitive. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Seven qualitatively different positions were found that were termed Never acceptable (12%), Urgency (4%), Family consent (33%), Religious concerns (15%), Family consent and urgency (10%), Depends on all circumstances (4%), and Always acceptable (11%). Vegans and vegetarians expressed the Never acceptable position more often than nonvegetarians. Health professionals expressed the Family consent position more often than the public. Regular church attendees expressed the Religious concerns position more often than atheists did. CONCLUSIONS: Few participants, mostly vegetarians, were opposed to xenotransplantation on principle. About one-third expressed positive views regarding xenotransplantation, either irrespective of circumstances or at least in those cases in which the patient's death is imminent and the family is not opposed for religious reasons. About one-half expressed positive views but deferred to the wishes of the family. The type of xenograft proposed had practically no effect on participants' views.
Assuntos
Implante de Prótese de Valva Cardíaca/psicologia , Próteses Valvulares Cardíacas/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Seleção de Pacientes , Transplante Heterólogo/psicologia , Adulto , Análise de Variância , Animais , Atitude do Pessoal de Saúde , Análise por Conglomerados , Tomada de Decisões , Família/psicologia , Feminino , França , Pessoal de Saúde/psicologia , Humanos , Consentimento Livre e Esclarecido/psicologia , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Religião e Psicologia , SuínosRESUMO
OBJECTIVE: The purpose of this study was to evaluate the effect of continuous nursing interventions on valve noise-related anxiety in patients undergoing mechanical mitral valve replacement (MVR) and to analyze its impact on patient quality of life. METHODS: Ninety patients who underwent mechanical MVR were divided into two groups. All patients in group A received routine nursing care. In addition to this intervention, an assigned nurse periodically provided patients in group B with continuous nursing interventions and ongoing health consultations during a 1-year follow-up. A hospital anxiety and depression (HAD) scale, a customized questionnaire and a Short Form Health Status 36 (SF-36) score questionnaire were used as the research tools. RESULTS: The postoperative HAD scores were better in group B than in group A, but the differences in most of the data were not statistically significant between the groups, except for HA sections 0-7 and 11-21. Based on the customized questionnaire, the subjective disturbance level was significantly lower in group B than in group A (the results of Q1 and Q4 were statistically significant). With regard to the SF-36 scores, group B was superior to group A in general health, emotional function and mental health, while the other dimensions had no significant difference. CONCLUSIONS: Compared with routine care, patients who received continuous care intervention after mechanical MVR had fewer anxiety symptoms and better quality of life.
Assuntos
Ansiedade/enfermagem , Implante de Prótese de Valva Cardíaca/enfermagem , Próteses Valvulares Cardíacas/psicologia , Valva Mitral/cirurgia , Ruído , Papel do Profissional de Enfermagem , Qualidade de Vida/psicologia , Idoso , Ansiedade/psicologia , Feminino , Implante de Prótese de Valva Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This article aimed to study the quality of life and anxiety of sexagenarian patients who underwent aortic biological vs mechanical valve replacement in a single center in China. METHODS: The clinical data of 78 patients aged 60 to 70 years who underwent aortic prosthetic valve replacement were retrospectively analyzed in our hospital from June 2017 to February 2018. Patients were divided into two groups depending on the type of prosthetic valve they received (biological valve group vs mechanical valve group). The SF-36 was completed by all patients at discharge and at one-year follow-up, and the cardiac anxiety questionnaire (CAQ) was also completed at one-year follow-up. RESULTS: There was no statistically significant difference between the two groups in general clinical data or SF-36 score at discharge. However, at one-year follow-up, the SF-36 scores were significantly higher in the biological valve group than in the mechanical valve group, and the CAQ scores in fear and anxiety, avoidance and attention in the mechanical valve group were significantly higher than those in the biological valve group. CONCLUSIONS: Based on the postoperative quality of life and anxiety scores of sexagenarian patients who underwent biological vs mechanical valve replacement in this study, a biological valve has more value than a mechanical valve for sexagenarians undergoing aortic valve replacement.
Assuntos
Ansiedade/etiologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Próteses Valvulares Cardíacas , Qualidade de Vida , Idoso , Estenose da Valva Aórtica/psicologia , Atenção , Bioprótese/psicologia , Medo , Feminino , Próteses Valvulares Cardíacas/psicologia , Implante de Prótese de Valva Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de TempoRESUMO
OBJECTIVE: To investigate the effect of valve noise on the quality of life (QOL) in Chinese patients who underwent mechanical mitral valve replacement. METHODS: We enrolled a total of 103 patients who underwent mechanical mitral valve replacement (MVR, CM valve in 52 patients, SJM valve in 51 patients) from January 2016 to December 2016 in our institution and used the SF-36 as an instrument to assess patients' QOL. RESULTS: Patients' QOL improved over time. Patients who experienced disturbances due to valve noise had lower SF-36 scores in each scale, especially in general health, vitality, and mental health. Only 8.74% (n = 9) of patients complained of valve noise 1 year after the operation compared to 19.42% (n = 20) in the first month after the operation. The number of patients who experienced disturbances due to valve noise decreased over time, with a P value of 0.58. Logistic regression analysis showed that female patients those aged < 60 years old had a higher risk of experiencing disturbances due to valve noise. The valve type (CM vs SJM), body mass index (BMI) and valve size showed no significant differences in patients who experienced disturbances due to continuous valve noise. The SF-36 results were similar in the CM group and SJM group 1 year after the operation. CONCLUSIONS: QOL evaluated by the SF-36 improved over time in Chinese patients who underwent mechanical MVR. Age less than 60 years and female sex were high risk factors for experiencing disturbances due to valve noise. CM and SJM mechanical valves demonstrated similar valve noise levels and impact on QOL in patients who experienced mechanical MVR.
Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Ruído/efeitos adversos , Qualidade de Vida/psicologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Seguimentos , Indicadores Básicos de Saúde , Próteses Valvulares Cardíacas/psicologia , Implante de Prótese de Valva Cardíaca/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND: Ischemic heart disease and heart failure often lead to sexual difficulties in men, but little is known about the sexual difficulties in women and patients with other heart diagnoses or the level of information patients receive about the risk of sexual difficulties. AIM: To investigate perceived sexual difficulties and associated factors in a mixed population of men and women newly diagnosed with heart disease and provide insight into sexual counseling and information given by health care professionals. METHODS: This article reports on a cross-sectional, questionnaire study sent to a randomly selected sample of men and women newly diagnosed with heart failure, ischemic heart disease, atrial fibrillation, or heart valve surgery. Eligible patients were identified by diagnosis using the Danish National Patient Register, which contains all diagnoses. OUTCOMES: Sexual difficulties were self-reported using single-item questions, and factors associated with sexual difficulties were collected from the survey and national registers. RESULTS: The study population consisted of 1,549 men and 807 women (35-98 years old) with heart failure (n = 243), ischemic heart disease (n = 1,036), heart valve surgery (n = 375), and atrial fibrillation (n = 702). Sexual difficulties were reported by 55% of men and 29% of women. In a multiple regression analysis, difficulties in men were associated with being older (≥75 years old; odds ratio [OR] = 1.97, 95% CI = 1.13-3.43), having heart failure (OR = 2.07, 95% CI = 1.16-3.71), diabetes (OR = 1.80, 95% CI = 1.15-2.82), hypertension (OR = 1.43, 95% CI = 1.06-1.93), receiving ß-blockers (OR = 1.37, 95% CI = 1.02-1.86), or having anxiety (OR = 2.25, 95% CI = 1.34-3.80) or depression (OR = 2.74, 95% CI = 1.38-5.43). In women, difficulties were significantly associated with anxiety (OR = 3.00, 95% CI = 1.51-5.95). A total of 48.6% of men and 58.8% of women did not feel informed about sexuality, and 18.1% of men and 10.3% of women were offered sexual counseling. CLINICAL IMPLICATIONS: Heart disease increases the risk of sexual difficulties and there is a need for improved information and counseling about sex and relationships for patients. STRENGTHS AND LIMITATIONS: This large nationwide survey of men and women combined a survey with administrative data from national registries. However, this study used non-validated single-item questions to assess sexual difficulties without addressing sexual distress. CONCLUSION: More than half the men and one fourth the women across common heart diagnoses had sexual difficulties. No difference was found among diagnoses, except heart failure in men. Despite guidelines recommending sexual counseling, sexual difficulties were not met by sufficient information and counseling. Rundblad L, Zwisler AD, Johansen PP, et al. Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study. J Sex Med 2017;14:785-796.
Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/psicologia , Aconselhamento Sexual/métodos , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Insuficiência Cardíaca/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/psicologia , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Percepção , Comportamento Sexual/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Heart transplantation (HT) obviously affects body image and integrity. However, there are very few empirical data post-transplant. METHODS: In a cross-sectional study, 57 HT patients were compared with 47 subjects with mechanical aortic valve replacement (AVR) using the Dresden-Body-Image questionnaire (DKB) and specific questions regarding integration of the organ/device. In addition, affective symptoms and quality of life (QoL) were assessed (12-Item Short-Form Health Survey and Hospital Anxiety and Depression Scale, HADS). RESULTS: DKB-35 scores did not differ. HT patients scored higher than AVR on specific questions regarding integration of the organ/device. AVR patients showed more affective disturbance and lower mental QoL than HT subjects. Affective scores correlated negatively with body image scores. Seventeen percent of all patients showed psychological distress (HADS scores >8). CONCLUSIONS: HT patients integrated the new organ well - and even better than AVR subjects did with the device. In general, our data corroborate a good adaptation process, in particular in HT patients. Similar to other reported data, a subgroup of 15-20% of patients shows stronger mental distress, including body image problems. These must be identified and treated by professionals. Patients with AVR deserve more attention in the future.
Assuntos
Afeto , Valva Aórtica/cirurgia , Imagem Corporal/psicologia , Transplante de Coração/psicologia , Próteses Valvulares Cardíacas/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Quality of life (QoL) measurements reported in observational studies are often biased, since patients who failed to improve are more likely to be unable to respond due to death or impairment. In order to observe the development of QoL in patients close to death, we analyzed a set of monthly QoL measurements for a cohort of elderly patients treated for aortic valve stenosis (AS) with special consideration of the effect of distance to death. METHODS: QoL in 169 elderly patients (age ≥ 75 years), treated either with transcatheter aortic valve replacement (TAVR; n = 92), surgical aortic-valve replacement (n = 70), or drug-based therapy (n = 7), was evaluated using the standardized EQ-5D questionnaire. Over a two-year period, patients were consulted using monthly telephone interviews or outpatient visits, leading to a total of 2463 time points at which QoL values, New York Heart Association (NYHA) Functional Classification and their status of assistance were assessed. Furthermore, post-procedural clinical events and complications were monitored. Linear and ordered logistic regression analyses with random intercept were carried out, taking into account overall trends and distance to death. RESULTS: QoL measures decreased slightly over time, were temporarily impaired at month 1 after the initial episode of hospitalization and decreased substantially at the end of life with a measurable effect starting at the sixth from last follow-up (month) before death. Many clinical complications (bleeding complications, stroke, acute kidney injury) showed an impairment of QoL measurements, but the inclusion of lagged variables demonstrated medium term (three months) QoL impairments for access site bleeding only. All other complications are associated with event-related impairments that decreased dramatically at the second and third follow-up interviews (month) after event. CONCLUSIONS: Distance to death shows clear effects on QoL and should be taken into account when analyzing QoL measures in the elderly patients treated for aortic valve stenosis. TRIAL REGISTRATION: German Clinical Trial Register Nr. DRKS00000797.
Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/psicologia , Próteses Valvulares Cardíacas/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pacientes/psicologia , Fatores de Risco , Inquéritos e Questionários , Resultado do TratamentoRESUMO
AIM: To evaluate the impact of a learning program on quality of life indicators in patients with prosthetic heart valves (PHV). SUBJECTS AND METHODS: One hundred and twenty-two patients with PHV were examined. A study group consisted of 72 patients who were trained at PHV school; a control group comprised 50 untrained patients. The comparison groups were matched for age, gender, education level, the underlying disease that had been a cause of heart disease, and the type of PHV. The SF-36 questionnaire assessing quality of life was used to evaluate the effectiveness of the learning program. RESULTS: At baseline, before cardiac surgery, the patients with PHV showed low physical and mental health indicators in both groups. At 6-month follow-up, the physical health component was increased by 23.8% in the control group and by 27.4% in the study group trained by the learning program (p < 0.05). Analysis of the scores of each scale of the questionnaire yielded significant results in both groups after 6 months of cardiac surgery (p < 0.05), which showed better quality of life. The comparison groups had significant differences only in the scores of the mental health component. Thus, following 6 months the mental health component was 24.1% higher in the learning program group than in the control one (p < 0.05). CONCLUSION: The learning program for patients with PHV, which is based on the principle of continuity of the in- and outpatient management, contributes to better quality of life mainly due to an improvement in the mental health component.
Assuntos
Implante de Prótese de Valva Cardíaca/psicologia , Próteses Valvulares Cardíacas/psicologia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Estudos de Casos e Controles , Feminino , Seguimentos , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosAssuntos
Bioprótese/psicologia , Catatonia/terapia , Eletroconvulsoterapia/métodos , Próteses Valvulares Cardíacas/psicologia , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Catatonia/etiologia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , ReoperaçãoRESUMO
BACKGROUND: Children with previous experience of infective endocarditis or with prosthetic heart valve are considered at very high risk for infective endocarditis. AIM: The aim of this study was to compare the dental health of a group of these children with a group of healthy controls and to determine parental awareness of the importance of good oral health. DESIGN: Oral examination was carried out in 28 children with previous infective endocarditis or a prosthetic heart valve to assess oral health. Findings were compared to a healthy control group of 28. Questionnaires were distributed to the parents to assess awareness of oral health. RESULTS: There was no significant difference in DMFT scores of study and control group (2.43 +/- 3.72 and 1.36 +/- 2.5 respectively) or in DMFT scores of study and control group (1.5 +/- 1.73 and 1.15 +/- 1.42 respectively), 36% of the study group had untreated caries. Parental knowledge of the link between oral health and infective endocarditis was excellent. CONCLUSIONS: There were no significant differences between the oral health of cardiac children and healthy children although the dmft and DMFT scores of the study group were high. Of concern was the proportion of children with untreated caries in spite of good dental awareness and attendance.
Assuntos
Assistência Odontológica para Doentes Crônicos/psicologia , Endocardite/prevenção & controle , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Saúde Bucal , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Índice CPO , Cárie Dentária/complicações , Cárie Dentária/prevenção & controle , Endocardite/etiologia , Próteses Valvulares Cardíacas/psicologia , Humanos , Pais/psicologia , Valores de Referência , Fatores de RiscoRESUMO
INTRODUCTION: A growing number of elderly undergo surgery of the aortic valve. It is therefore important to investigate their postoperative course concerning quality of life. MATERIAL AND METHODS: A questionnaire was designed and distributed, which retrospectively illustrated quality of life pre- and postoperatively in a cohort consisting of 124 patients aged >or= 75 years extracted from the Western Danish Cardiac Database. All patients were operated at Department T, Odense University Hospital in the period 2003-2005. All had a prosthetic aortic valve inserted without any concomitant procedure. Cause and date of death was obtained from death certificates. The median follow-up was 43 month (range: 36-72). RESULTS: The patients' well-being generally showed an increase of 35% following surgery. Social interactions were enhanced in 10% of the cohort. After surgery, 14% stated that they now had a good level of physical activity, 1% expressed good energy level and 6% greater joy. The study showed a slight increase in the need for help for everyday life. The patients' New York Heart Association (NYHA) class was improved in 25%, unchanged in 60% and worsened in 15% of patients. Regarding the patients' own expectations to the outcome, 49% stated "as expected", 37% "better" and 14% "worse than expected". The distribution on housing types showed only moderate variation from the background population. The late mortality rate corresponded to that of the age-matched background population. CONCLUSION: Postoperatively, an improved quality of life was found in the majority of patients >or= 75 years who had undergone aortic valve surgery, and long-term survival was not affected. Hence, it is justified to perform this type of surgery in the elderly.
Assuntos
Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Seguimentos , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Período Pós-Operatório , Período Pré-Operatório , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Taxa de Sobrevida , Resultado do TratamentoRESUMO
To assess the quality of life after biological and mechanical aortic valve replacement, data of 136 patients were assessed retrospectively after 2 years of follow-up. Bioprostheses were implanted in 53 patients with a mean age of 74 years, and mechanical prostheses were used in 83 with a mean age of 64 years; there were 47 women and 89 men. Quality of life was evaluated using the Short Form 36-Item Health Survey questionnaire. Physical function scores were significantly better in patients with a mechanical prosthesis. Mental health indices were identical in both groups. Younger patients with mechanical valves and older patients with biological valves had significantly better item scores. In all age groups, men tended to have better scores than women, but a significant difference was noted only in the physical functioning index. The quality of life in patients with mechanical and biological valves was similar at 2 years postoperatively.
Assuntos
Insuficiência da Valva Aórtica/psicologia , Insuficiência da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/psicologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/mortalidade , Feminino , Seguimentos , Nível de Saúde , Próteses Valvulares Cardíacas/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND AIM OF THE STUDY: Mechanical heart valves are preferred for younger patients in order to avoid valve structural deterioration, but bioprosthetic valves are favored for older patients to avoid long-term anticoagulation. With increasing patient longevity, controversy persists regarding the valve of choice in the 65- to 75-year-old population. With improving patient survival, long-term quality of life (QOL) is a critical element in helping to resolve this controversy. METHODS: A retrospective analysis was conducted of 1,104 consecutive patients, aged 65-75 years, who underwent valve replacement between July 1976 and December 1999. Valves implanted were either a Carpentier-Edwards (CE) porcine bioprosthesis (596 patients) or a St. Jude Medical (SJM) mechanical valve (508 patients), with and without concomitant coronary artery bypass grafting. QOL was assessed using the Short Form (SF-36) Health Survey for both groups at the time of follow up, which was 98.2% complete. Comparable patient groups were analyzed within quintiles by propensity score analysis. RESULTS: Operative mortality was 9.4% (n = 56) for CE patients, and 5.3% (n = 27) for SJM patients (p = 0.014). Propensity score analysis revealed no significant difference in operative mortality between groups in any of the five quintiles. Actuarial survival for hospital survivors favored SJM patients (p = 0.005). However, when compared within quintiles, there was no significant difference between groups. QOL summary scores were significantly higher for physical health (p = 0.007) for SJM patients, but similar between valve groups for mental health. Comparison within quintiles revealed no significant difference between the groups in either area. CONCLUSION: When comparing the outcomes of mechanical versus bioprosthetic valve replacement, considerable care must be exercised to ensure the clinically relevant similarity of groups. When evaluating comparable patient groups, there was no advantage in either survival or QOL for patients aged 65-75 years receiving a CE or SJM valve.
Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/psicologia , Qualidade de Vida , Idoso , Bioprótese , Feminino , Seguimentos , Doenças das Valvas Cardíacas/psicologia , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery. METHODS: Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery. Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument. Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors. RESULTS: Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery. A similar effect on psychosocial functioning fell short of significance. An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months. The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores. CONCLUSIONS: Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery.
Assuntos
Ponte de Artéria Coronária/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Qualidade de Vida/psicologia , Adaptação Psicológica , Transtorno Depressivo/epidemiologia , Nível de Saúde , Próteses Valvulares Cardíacas/psicologia , Humanos , Inventário de Personalidade/estatística & dados numéricos , Cuidados Pré-Operatórios , Prognóstico , Índice de Gravidade de Doença , Ajustamento Social , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To examine the multiple impacts of valve replacement on the lives of young adults. METHODS: Patients (N=500) between age 18 and 50 who had aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed annually. Events, functional status, and quality of life were examined with regression models. RESULTS: Median follow-up was 7.1+/-5.3 years (maximum 26.7 years). Five, 10, and 15-year survival was 92.7+/-1.7, 88.3+/-2.4 and 80.1+/-4.7% after AVR, and 93.1+/-2.3, 79.5+/-4.3 and 71.5+/-5.4% after MVR, respectively. Survival decreased with concomitant coronary disease (hazard ratio (HR): 4.5) and preoperative LV grade (HR: 2.0/grade increase) in AVR patients, and with atrial fibrillation (HR: 5.5), coronary disease (HR: 5.7), preoperative left atrial diameter (HR: 3.0/cm increase) and NYHA class (HR: 2.1/class increase) in MVR patients. Despite reoperation, late survival was equivalent between bioprostheses and mechanical valves in both implant positions. The ten-year cumulative incidence of embolic stroke was 6.3+/-2.4% for mechanical AVR patients, 6.4+/-2.9% for bioprosthetic AVR patients, 12.7+/-3.9% for mechanical MVR patients, and 3.1+/-3.1% for bioprosthetic MVR patients. Atrial fibrillation (HR: 2.8) and smoking (HR: 4.0) were risk factors for stroke in MVR patients. In AVR patients, SF-12 physical scores, freedom from recurrent heart failure, and freedom from disability were significantly higher in bioprosthetic than mechanical valve patients. Career or income limitations were more often subjectively linked to a mechanical prosthesis in both implant positions. CONCLUSIONS: Late outcomes of modern prosthetic valves in young adults remain suboptimal. Bioprostheses deserve consideration in the aortic position, as mechanical valves are associated with lower physical capacity, a higher prevalence of disability, and poorer disease perception. Early surgical referral and atrial fibrillation surgery may improve survival after MVR.
Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Adolescente , Adulto , Fatores Etários , Anticoagulantes/administração & dosagem , Bioprótese , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/etiologia , Doenças das Valvas Cardíacas/reabilitação , Próteses Valvulares Cardíacas/psicologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/psicologia , Implante de Prótese de Valva Cardíaca/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Falha de Prótese , Qualidade de Vida , Reoperação , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
BACKGROUND AND AIM OF THE STUDY: Mechanical heart valves produce short clicking sounds during closure. These closing sounds are annoying for some patients and their partners by causing sleeping disorders or social embarrassment. Various methods for measuring the sounds have been developed both in vitro and in vivo using calculation of A-weighted sound pressure level or loudness according to ISO 532 B. The study aim was to evaluate the relevance of different psychoacoustic parameters in the evaluation of closing sounds. METHODS: Closing sounds were recorded from patients with ATS valves (n = 13), On-X valves (n = 18) and St. Jude Medical heart valve prostheses (n = 16). The sounds were recorded 5 cm above the chest of patients in a supine position, in a sound-insulated chamber. The mean peak values of loudness and sharpness were calculated and used to determine the psychoacoustic annoyance using a modification of the Widmann formula. This was verified by a listening test for ranking closing sounds of different level and sharpness by annoyance. RESULTS: There was no statistically significant independence between loudness difference or psychoacoustic annoyance difference and agreement among the test persons. For the valves, loudness ranged from 0.07 to 2.57 sone, and the psychoacoustic annoyance from 0.1 to 5.4. CONCLUSION: The results of this study showed that both sharpness and loudness have a significant influence on annoyance from closing sounds from mechanical heart valves, and indicated that the substantial variation in the parameters may be due to individual patient physiology.
Assuntos
Próteses Valvulares Cardíacas/psicologia , Percepção Sonora , Ruído , Psicoacústica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Decúbito DorsalRESUMO
An aortic valve was replaced in a schizophrenic patient with violent behaviour. The usual protocol was altered and strategies to prevent accidents before and after surgery were devised. Minimally invasive surgery, administering sedation during the critical recovery period, and therapeutic use of communication as a psychological intervention were effective strategies. The patient recovered well and was discharged on day 14 after surgery.
Assuntos
Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/psicologia , Esquizofrenia/complicações , Dor no Peito , Humanos , Masculino , Pessoa de Meia-Idade , Síncope , Resultado do TratamentoRESUMO
OBJECTIVE: The closure clicks of mechanical heart valve prostheses' leaflets are quite often clearly audible. The study describes the effects of subjective valve sound perception on the patients' quality of life and analyses factors that might contribute to valve noise-related discomfort. METHODS: We included 556 patients who received a mechanical valve prosthesis and participated in the study in our institution from 1994 to 1998. All compiled the standardised questionnaire Short-Form-36 Health Survey (SF-36) and indicated their subjective disturbance grade pre- and postoperatively, then every 6 months up to 2 years. A series of factors was scanned for correlation with unpleasant noise perception. RESULTS: Two years after the operation, only 5.8% classified their valve sounds as 'quite' or 'very much' disturbing. Age <60 years and being female were statistically significant factors for persisting unease caused by valve sounds. Without one of these factors, severe disturbance chance was 1.5%. As expected, quality of life improved after surgery. Patients disturbed seriously by valve noise showed significantly lower mean life quality values on each SF-36 scale. CONCLUSION: Patients (94.2%) with mechanical heart valve replacement have no persistent complaints about the valve noise. The grade of annoyance by valve noise is paralleled by lower average quality of life. Age under 60 years or being female increases the probability of severe disturbance due to mechanical valve sounds. It remains unclear whether the disturbing noise is reason or consequence of lower quality of life.