Improved quality of life is a major goal for cardiac surgery. This review concerns 29 articles published between January 2004 and December 2010. Only nine studies present preoperative and postoperative registered quality of life data. These studies have a short follow-up and a limited number of patients included. Most other studies starts at a certain point in the follow-up and compare different patient groups or techniques, but do not evaluate postoperative vs. preoperative quality of life. In an era of evidence-based medicine, there is a lack of major and well-organized clinical studies dealing with quality of life after cardiac surgery. Based on this review, five requirements for 'good' studies on this subject can be formulated: information about the total number of patients that could be included; the number of patients actually included; information about preoperative quality of life; information on what was done about patients with missing data; and at least minimum information about demographics, co-morbidity and the cardiac risk of patients who were not included or who dropped out. These points seem to us to be essential for validation of the results presented.

Of 415 patients, 200 undergoing aortic valve replacement (AVR) and 215 undergoing AVR in combination with myocardial revascularization [coronary artery bypass grafting (CABG)], had complete preoperative health-related quality of life (HRQOL) data. From this group, 224 patients had a follow-up of one year. To assess HRQOL, the EuroQol instrument was used. The EQ-5D index score was calculated, based on separate scores from five health domains, to express the global health status of the patient. The EQ visual analogue scale (VAS) was used to describe patients' subjective HRQOL. At baseline, the EQ-5D showed no significant differences between the two groups. The EQ-VAS score, however, was statistically significantly lower in the AVR+CABG patients (P=0.031). At one year postoperatively, both groups showed a statistically significant increase in the EQ-VAS (P=0.001 and P=0.001, respectively) and the EQ-5D (P=0.001 and P=0.001, respectively). This increase, however, could only be ascertained for the domain 'pain/discomfort' (P=0.001) in the AVR group, and for 'mobility' (P=0.018), 'usual activities' (P=0.001), 'pain/discomfort' (P=0.001) and 'anxiety/depression' (P=0.001) in the AVR+CABG group. At baseline, coronary artery disease had a negative influence on the patients' HRQOL, especially on the EQ-VAS. Postoperatively, all patients experienced significantly better HRQOL. However, the patients undergoing combined surgery experienced more benefit from their operation.

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