BACKGROUND Surgical intervention for thoracic aortic aneurysms is high risk. Understanding changes in health-related quality of life before and after endovascular stent grafting and open surgical repair can aid treatment decision-making. METHODS The Effective Treatments for Thoracic Aortic Aneurysms ('ETTAA') study (ISRCTN04044627) was a longitudinal, observational study. Adults with new/existing arch or descending thoracic aortic aneurysms greater than or equal to 4 cm in diameter were followed from 2014 to 2022. Five domains of health-related quality of life (Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression) were recorded using the EuroQoL, five dimensions, five levels ('EQ-5D-5L') questionnaire and analysed using a range of longitudinal mixed models. RESULTS Of 886 thoracic aortic aneurysm participants, 824 completed at least 2 questionnaires. Patients had slightly worse health-related quality of life than age-matched norms. Without surgery, deterioration occurred over time in Mobility (0.072/year (95% c.i. 0.042 to 0.101), P < 0.001) and Self-Care (0.039/year (95% c.i. 0.018 to 0.061), P < 0.001) in both sexes and Pain/Discomfort in women (0.069/year (95% c.i. 0.020 to 0.118), P = 0.005). For 6 weeks after endovascular stent grafting, there was a significant impairment in Self-Care (0.214 (95% c.i. 0.112 to 0.316), P < 0.001) and (for women only) in Usual Activities (0.625 (95% c.i. 0.338 to 0.911), P < 0.001), which then returned to pre-endovascular stent grafting levels. Six weeks after open surgical repair, the impairment in health-related quality of life was greater (Mobility 0.492 (95% c.i. 0.314 to 0.669), Self-Care 0.474 (95% c.i. 0.364 to 0.583), Usual Activities 1.469 (95% c.i. 1.042 to 1.896), and Pain/Discomfort 0.561 (95% c.i. 0.363 to 0.760), all P < 0.001) and took longer to return to pre-open surgical repair levels, partly due to increased complications and longer hospitalization. Anxiety/Depression decreased after open surgical repair (-0.214 (95% c.i. -0.326 to -0.101), P < 0.001). Age, sex, frailty, smoking, New York Heart Association class, and chronic obstructive pulmonary disease were significantly associated with health-related quality of life. CONCLUSION Without intervention, health-related quality of life declines as age increases. Changes in health-related quality of life should contribute to surgical treatment decision-making.

中文翻译：

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胸主动脉瘤患者的纵向健康相关生活质量。


背景胸主动脉瘤的手术干预风险很高。了解血管内支架移植和开放手术修复前后与健康相关的生活质量的变化有助于治疗决策。方法 胸主动脉瘤的有效治疗（“ETTAA”）研究 (ISRCTN04044627) 是一项纵向观察性研究。 2014 年至 2022 年，对直径大于或等于 4 厘米的新发/现有胸主动脉瘤或降主动脉瘤的成人进行了随访。健康相关生活质量的五个领域（活动能力、自我护理、日常活动、疼痛/不适、使用 EuroQoL、五个维度、五个水平（“EQ-5D-5L”）调查问卷记录并使用一系列纵向混合模型进行分析。结果 886 名胸主动脉瘤参与者中，824 人完成了至少 2 份问卷。患者的健康相关生活质量比年龄匹配的正常人稍差。如果不进行手术，随着时间的推移，活动能力（0.072/年（95% ci 0.042 至 0.101），P < 0.001）和自我护理（0.039/年（95% ci 0.018 至 0.061），P < 0.001）出现恶化。男女均存在疼痛/不适（0.069/年（95% CI 0.020 至 0.118），P = 0.005）。血管内支架移植后 6 周，自我护理（0.214（95% ci 0.112 至 0.316），P< 0.001）和日常活动（仅针对女性）显着受损（0.625（95% ci 0.338 至 0.338） 0.911)，P< 0.001)，然后恢复到血管内支架移植前的水平。开放手术修复后六周，与健康相关的生活质量受损更大（活动能力 0.492（95% ci 0.314 至 0.669）、自我护理 0.474（95% ci 0.364 至 0.583）、日常活动 1.469（95% ci 1.042 至 1.896)，疼痛/不适 0。561（95% CI 0.363 至 0.760），所有 P < 0.001），并且需要更长的时间才能恢复到开腹手术修复之前的水平，部分原因是并发症增加和住院时间更长。开放手术修复后焦虑/抑郁有所下降（-0.214（95% CI -0.326 至 -0.101），P < 0.001）。年龄、性别、虚弱、吸烟、纽约心脏协会分级和慢性阻塞性肺疾病与健康相关的生活质量显着相关。结论 如果不进行干预，与健康相关的生活质量会随着年龄的增长而下降。与健康相关的生活质量的变化应有助于手术治疗决策。