Measurement of health-related quality of life post aortic valve replacement via minimally invasive incisions

Abstract

Background Minimally invasive aortic surgery is growing in popularity among surgeons. Although many clinical reports have proven both the safety and efficacy from a surgical point of view, there are few data regarding its impact on patients’ quality of life and whether there is a difference between ministernotomy and minithoracotomy from the patient perspective. Methods This prospective, questionnaire-based, nonrandomized study included 189 patients who underwent aortic valve replacement via a minimally invasive incision between May 2014 and December 2020 and completed at least 1 year of follow-up. The study uses the RAND SF 36-Item Health Survey 1.0 to assess and compare health-related quality of life between ministernotomy and minithoracotomy. Results There was a statistically significant improvement in the minithoracotomy group with regard to physical functioning, role limitation due to a physical problem, and social functioning (79.69 ± 20.72, 75.28 ± 26.52, 87.91 ± 16.98) compared to the ministernotomy group (70.31 ± 22.88, 58.59 ± 31.17, 66.15 ± 27.32) with p values (0.0036, 0.0001, < 0.0001), respectively. Conclusions Both minimally invasive aortic valve incisions positively impacted patient quality of life. The minithoracotomy incision showed significant improvements in physical capacity and successful patient re-engagement in daily physical and social activities. This, in turn, positively improved their general health status compared to the 1-year preoperative status. Trial registration: This study was approved by the Research Ethics Committee (REC) at the Faculty of Medicine, Ain Shams University, under the number code (FWA 000017585, FAMSU R 91 /2021).

Ministernotomy aortic valve replacement: The cost of preference

“…3,13 Interestingly, right minithoracotomy approaches to AVR, although associated with increased early postoperative pain scores, do demonstrate improved long-term quality of life scores compared to MS AVR. 14 This comes at an even greater cost, with one study calculating that when compared to FS AVR, minithoracotomy AVR was associated with ~$4000 in excess costs per case, whereas MS AVR was associated with only ~$290 in excess costs per case. 15 It must be remembered that the inability to blind patients and providers to the type of incision confounds even randomized analysis of quality-of-life scores.…”

“…However, randomized data suggest that MS AVR is associated with increased cost, and conflicting results are seen with regard to quality‐of‐life scores 3,13 . Interestingly, right minithoracotomy approaches to AVR, although associated with increased early postoperative pain scores, do demonstrate improved long‐term quality of life scores compared to MS AVR 14 . This comes at an even greater cost, with one study calculating that when compared to FS AVR, minithoracotomy AVR was associated with ~$4000 in excess costs per case, whereas MS AVR was associated with only ~$290 in excess costs per case 15 .…”