Patient Safety and Quality

Mitral valve repair, when compared with replacement, leads to better quality of life

Problems with the mitral valve, which allows blood to flow from the heart's left atrium into the left ventricle (the main pumping chamber of the heart), can lead to serious heart complications, including heart failure. Mitral valve replacement has been the standard of surgical care for mitral valve disease for over 30 years. Many considerations influence the decision to repair or replace mitral valves. However, a new study found that patients who had mitral valve repair reported a better health-related quality of life (HRQOL) 18 months after surgery compared with patients who underwent mitral valve replacement. In addition, physical and mental improvements were larger for patients who underwent repair compared with the modest improvements seen in patients receiving replacement.

Artyom Sedrakyan, M.D., Ph.D., of the Agency for Healthcare Research and Quality, and colleagues found that HRQOL improvements were substantial (higher than age-adjusted U.S. norms) in the valve repair group across most domains (physical role and functioning, vitality, social functioning, and mental health). In the valve replacement group, improvements were in fewer domains (bodily pain, vitality, and mental health) and generally were slightly lower than population norms. However, the only change that was significant between the two groups was improved social functioning in the valve repair group.

These findings may help surgeons when discussing surgery options with patients. Many studies have suggested an advantage to valve repair over replacement. They cite less risk of heart failure death or complications and lower rates of embolism or anticoagulant-related hemorrhage compared with valve replacement. This study's finding of a tendency toward higher HRQOL associated with valve repair adds to evidence of the benefits of valve repair. However, the researchers caution that the findings need to be validated in a large multicenter study.

See "Health related quality of life after mitral valve repairs and replacements," by Dr. Sedrakyan, Viola Vaccarino, M.D., Ph.D., John A. Elefteriades, M.D., and others, in the September 2006 Quality of Life Research 15, pp. 1153-1160. Reprints (AHRQ Publication No. 07-R015) are available from the AHRQ Publications Clearinghouse.

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