Post hoc patient satisfaction with the choice of valve prosthesis for aortic valve replacement: results of a single-centre survey

Objectives: Our goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR).

Methods: We surveyed 113 patients who were operated on for AVR at 60-70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Decisional conflict was defined as the post hoc uncertainty perceived by patients regarding their choice of prosthesis.

Results: The survey was performed at a median of 5.2 (3.2-8.1) years after the AVR. Patients with a biological valve were older (BIO: 68.4 years [66.2-69.4] vs MECH: 63.9 [61.9-66.7]; P < 0.001). Global post hoc satisfaction with prosthesis choice was high in both groups (MECH: 95.9%; BIO: 100%), and 85.1% (MECH) and 92.3% (BIO) of them would repeat their choice. Conflict about their decision was equal (MECH: 30.3%; BIO: 32.6%) for different reasons: MECH patients experienced more anticoagulation-related inconvenience (25.9% vs 0%), fear of bleeding (31.1% vs 0%) and prosthesis noise (26.2% vs 0%), whereas more BIO patients feared prosthesis failure (39.7% vs 17.4%) or reoperation (43.5% vs 18.1%). Active involvement in the decision (odds ratio 0.37, 95% confidence interval 0.16-0.85; P = 0.029) and adequate information about the prosthesis (odds ratio 0.34, 95% confidence interval 0.14-0.86; P = 0.020) decreased the risk of conflict about the decision.

Conclusions: Although 30% of the responders showed a decisional conflict related to prosthesis-specific interferences, global patient satisfaction with the prosthesis choice for AVR is excellent. Increasing the patient's involvement in the prosthesis choice through shared accountability and improved information is recommended to decrease the choice-related uncertainty.