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II. ДИАГНОСТИКА
ESTIMATION OF PATIENTS LIFE QUALITY WITH CONGENITAL HEART DISEASE AFTER UNIVENTRICULAR CORRECTION: LONG-TERM STUDY
UDC 616.12-007.1-053.1089.168-058
Sagatov I.Ye.21, Galiyev B.A.2
1National Science surgery centre named afterA.N. Syzganov, Department of cardiosurgery 2Kazakh Medical university of continuous education, Almaty, Kazakhstan
ABOUT THE AUTHOR
Inkar Ye. Sagatov - surgeon of Cardiac surgery department of the NSCS n/a A.N. Syzganov, dr. med., e-mail: [email protected].
Abstract
There is given an estimation of patients quality life with congenital heart diseases whom were done the operation univentricular correction by Fontan. The life quality of patients after Fontan operation in modification of atria-pulmonary anastomosis, total cavapulmonary anastomosis and extracardiac conduit were rather lower than average indicators, though they have high scales. The highest indicators of questionnaire SF-36 were characteristic for Fontan operation in modification of extracardiac conduit, but the lowest indicators were characteristic for atria-pulmonary anastomosis.
Keywords
quality of life, congenital heart disease, univentricular correction.
Б1ркарыншальщ отадан кейшп туа б1ткен журек акаулары бар наукастардьщ eMip сапасын багалау: алшак зерттеу
Сагатов I.E.21, faлиeв Б.А.2
1А.Н. Сызгановатында?ы¥лттык,?ылымихирургия орталь™, Кардиохирургия бел1мшеЫ 2Казак, медициналык,уздказ 6miM берууниверсител, Алматы, Казахстан
АВТОРЛАРТУРАЛЫ
Саратов 1цкэр Ергалиулы - А.Н. Сызганов атын. YFXO кардиохирургия бешмшеашц дар1гер-хирурп, м.г.д, e-mail: [email protected].
Ацдатпа
Фонтен бойынша б1ркарыншалык ота жасалеан жэне журект1ц туа б'пкен акаулары бар наукастардыц eMip сапасы багаланды. Фонтен операциясыныц журекше-вкпел1к анастомозы, тотальды кавопульмоналдык анастомозы жэне экстракардиалдык модификациялары жасалеан наукастардыц eMip сапасы ортастатистикалык керсетюштермен салыстырганда темен болып шыкты, б1ракжалпы алганда жотары болды. SF-36 сауалнамасыныц ец жотары керсетюштер1 Фонтен операциясыныц экстракардиалдык модификаиясы жасалеан наукастарта тэн бол-са, ал ен теменш щрекше-екпелканастомозга тэн болды.
Туйш сездер
euip сапасы,
журекгщ туа б'пкен акдуы, б1рк,арыншалык, коррекция.
Оценка качества жизни пациентов с врожденными пороками сердца после одножелудочковой коррекции: отдаленное исследование
Сагатов И.Е.21, Галиев Б.А.2
'Национальный научный центрхирургии им. А.Н. Сызганова, Отделение кардиохирургии 2Казахский медицинский университет непрерывного образования, Алматы, Казахстан
ОБ АВТОРАХ
Сагатов Инкар Ергалиевич - врач-хирург Отделения кардиохирургии ННЦХим.АН. Сызганова, д.м.н., e-mail: [email protected].
Аннотация
Приведена оценка качества жизни пациентов с врожденными пороками сердца, которые перенесли одноже-лудочковую коррекцию по Фонтену. Оказалось, что качество жизни пациентов после операции Фонтена в модификациях предсердно-легочного анастомоза, тотального кавопульмонального анастомоза и экстракардиального конудита несколько ниже, чем среднестатистические показатели, хотя достаточно высоки. Наиболее высокие показатели опросника SF-36 были характерны для операции Фонтена в модификации экстракардиального кондуита, наименьшие - предсердно-желудочкового анастомоза.
Ключевые слова
качество жизни, врожденный порок сердца, одножелудочковая коррекция.
Picture 1.
Patients' life quality infar period after Fontan operation in modifications APA, TCPA and EC (according questionnaire SF-36). Note: PF-Physical functioning; RPF-role physical functioning; BP-bodily pain; GH-general health; VT-vital-ity; SF-social functioning; REF-role emotional functioning; MH-mental health.
Introduction
Nowadays, in estimation of effective surgery treatment, also in hemodynamical correction of difficult congenital heart disease (CHD) with univen-tricular hemodynamic, research of life quality have important meaning [1-4]. It is due to that in main cases information about social and psychological wellness of patients in far period fall down from doctor's attention. Besides that, the meaning of life quality becomes the search object and scale that have defining methods and criteria of quantity estimation. In connection with it, one of the important criteria on full estimation of effectiveness in surgery help for patients with CHD is the life quality [5-12].
Aim of research is to estimate the life quality of patients with CHD in far period after Fontan opera-tionwith common profile questionnaire SF-36.
Material and methods
In research, 67 patients with CHD were participants. They had Fontan operation in different modifications. 62 patients were operated from 1989 until 2004 in Science Cardiovascular centre named after A.N. Bakoulev RAMS, 5 patients - in different clinics of Kazakhstan from 2004 until 2009. Fontan operation was done in modifications right atria-pulmonary anastomosis (APA), total cavopulmonary anastomosis (TCPA) and extracardiac conduit (EC). The age of patients on operation period were in middle 10,5±4,6 years. In far period after research middle age were 9,4±6,7. The quantity of patients after APA -11, after TCPA - 20 and after Fontan operation in modification EC - 36.
The estimation of life quality was done with using short version of common questionnaire MOS SF-36 (Medical Outcome Study 36-item short form health survey). Questionnaire including 36 questions and 8 scales. The results showed as rating in scores of scale, the most high rating shows the high
life quality rate. Indexes of every rate in questionnaire SF-36 various between 0 and 100, where 100 is full wellness. All indexes forms two wellness components: physical and psychological.
Statistical analysis were done with help of program Statistica 5.5. The middle values showed with standard deviation (M±m). Variety between middle values considered true in meanings p<0,05.
Results
According to results, physical component of patients life quality after Fontan operation lower than in common population (pic. 1). Efficient variety comes out in compare index of patients life quality with middle population data's in next scales of questionnaire SF-36: physical functioning, role physical functioning and general health. However, it's noticed that in two positions of questionnaire (role emotional functioning and mental health), that is referred to psychological status of patient after operation, there are some highly scales of life quality above middle population database. Social functioning of patients in spite of Fontan operation method always lower than in common population, it shows second social defect, which appears due to changes in relationships of people to patients. At the same time, the main scales of life quality in far period after Fontan operation showed more than 50 scores by SF -36 questionnaire.
Compared analysis of patients life quality in male and female shows that female's physical and social adaptation after hemodynamical correction is higher than male's. Though, in psychological relationship male patients have higher scales as statistics shows, but males give high estimation to themselves than females.
Patients life quality in I and II FC according to functional criteria NYHA, showed that psychological status of I FC patients not always higher than II
PF
RPF
BP
GH
VT
SF
REF
MH
■ Middle population database
□ Atria-pulmonary anastomosis
□ Total cavopulmonary anastomosis
□ Extracardiac conduit
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ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 4-2015
FC, in some scales have lower scores. It's noticed attention on emotional wellness of patient and role of emotional functioning in community after Fontan operation in modification TCPA and EC occurred more labile, improving and stabilizing of which going in some period, and it exceeds physical adaptation period.
Discussion
It was found, that clinic stabilization of patients wellness after Fontan operation noticed in far periods and appear in 1-2 years, improvement of hemodynamical in silence and hard working only in 3-4 years [1,3,4,5]. Researchers on patients life quality with difficult CHD in far period after Fontan operation were done in long period [6,7,8,9]. According to publication of van den Bosch (2004) adult patients after Fontan operation in far period had low life quality scales in physical functioning, general and mental health,
References
1. Kassirskii G.I., Zotova L.M. Rehabilitation of patients after surgical treatment of congenital heart disease -M.: NTSSSH n/a A.N. Bakulev, RAMS, 2007. - 136 p. (in Russ.).
2. Novik A.A., lonovaT.I. Guidance on Quality of Life Research in medicine. - SPb .: Neva M .: Olma-Press, 2002. - 315 p. (in Russ.).
3. Podzolkov V.P., Chiaureli M.R., Zelenikin M.M., Yurlov I.A. Surgical treatment of congenital heart disease by hemodynamic correction. M .: NTSSSH n/a Bakulev RAMS, 2007. - 242 p. (in Russ.).
4. Sagatov I. Ye. The quality of life of patients with congenital heart disease in the long-term period after hemodynamic correction. Proceed, of XI Annual Session of NTSSSH n/a A.N. Bakulev RAMS with the All-Russian Conference of Young Scientists. M., 2007,- v.8. - No. 3. - p.239. (in Russ.).
5. Sagatov I.Ye. Some aspects of the evaluation of the quality of life of patients with congenital heart disease in the long-term period after odnozheludochko-voy correction. Consilium - 2009 - №3-4 - p.4-5. (in Russ.).
6. Atz A.M., Travison T.G., McCrindle B.W., Mahony L., Glatz A.C., Kaza A.K., Breitbart R.E., Colan S.D., Kaltman J.R., Margossian R., Pasquali S.K., Wang Y., Gersony W.M. Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection. Cardiol Young. 2013 Jun; 23(3): 335-343.
in compare with middle population database of Denmark Kingdom [11].
As results showed, patients with univentricular bloodstream in far period after such type of circling had lower life quality in compare with middle population database (advantage in physical component). Life quality scales were compared with middle values of healthy population of European part in Russia. But in some scales of questionnaire that showed psychological quality of life noticed more higher scores than in common population. It concerns some cases when patients give high estimation to their mental health at the moment of writing questionnaire.
Conclusion
Patients life quality by questionnaire SF-36 in far period after Fontan operation in modification EC, TCPA and APA rather high, it provides active life without any social, physical and psychological problems.
7. d'Udekem Y, Cheung MM, Setyapranata S, Iyengar AJ, Kelly P, Buckland N, Grigg LE, Weintraub RG, Vance A, Brizard CP, Penny DJ. How good is a good Fontan? Quality of life and exercise capacity of Fon-tans without arrhythmias. Ann Thorac Surg. 2009 Dec; 88(6): 1961-1969.
8. Idorn L, Jensen AS, Juul K, Overgaard D, Nielsen NP, Smrensen K, Reimers Jl, Smndergaard L. Quality of life and cognitive function in Fontan patients, a population-based study. Int J Cardiol. 2013 Oct 9; 168(4): 3230-3235.
9. Pike NA, Evangelists LS, Doering LV, Eastwood JA, Lewis AB, Child JS. Quality of life, health status, and depression: comparison between adolescents and adults after the Fontan procedure with healthy counterparts. J Cardiovasc Nurs. 2012 Nov-Dec; 27(6): 539-546.
10.Sagatov I.Ye. Health-related life quality of practically healthy people residing in Almaty city (Kazakhstan). Med and Health Science J (Prague) 2010; Dec 4:99100.
11. Van den Bosch AE, Roos-Hesselink JW, Van Domburg R, Bogers AJ, Simoons ML, Meijboom FJ. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol 2004 May 1; 93(9):1141-1145.
12.Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36)1: conceptual framework and item selection. Med Care 1992; 30:473-483.
