Postoperative Quality of Life After Full-sternotomy and Ministernotomy Aortic Valve Replacement

Perrotti, Andréa; Francica, Alessandra; Monaco, Francesco; Sponga, Sandro; El-Dean, Zein; Salizzoni, Stefano; Loizzo, Tommaso; Salsano, Antonio; Cesare, A. Di; Benassi, Filippo; Castellà, Manuel; Rinaldi, Mauro; Chocron, Sidney; Vendramin, Igor; Faggian, Giuseppe; Santini, Francesco; Nicolini, Francesco; Milano, Aldo Domenico; Ruggieri, Vito Giovanni

doi:10.1016/j.athoracsur.2021.11.055

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Minimally-invasive approaches limit visualization during operation and may require different cardioplegia and cannulation strategies, and is more technically demanding. 7,14,23 Reflectively, the conversion rate varied from 0% to 11.8% between studies in our study. Additionally, mean CPB time ranged from 59 to 144 min with MS and 57 to 141 min with RMT, and heterogeneity between those studies was noted.…”

Section: Discussionmentioning

confidence: 54%

“…While the present study showed better operative mortality with MS compared to FS and RMT, we need to reacknowledge that minimally invasive approaches including MS and RMT are not for all surgeons or patients requiring SAVR. Minimally‐invasive approaches limit visualization during operation and may require different cardioplegia and cannulation strategies, and is more technically demanding 7,14,23 . Reflectively, the conversion rate varied from 0% to 11.8% between studies in our study.…”

Section: Discussionmentioning

confidence: 70%

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Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

Ogami

Yokoyama

Takagi

et al. 2022

Journal of Cardiac Surgery

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Background Outcome comparisons after surgical aortic valve replacement (SAVR) with minimally invasive approaches including mini‐sternotomy (MS) and right mini‐thoracotomy (RMT) and full sternotomy (FS) have been conflicting. Furthermore, the synthesis of mid‐term mortality has not been performed. Methods MEDLINE and EMBASE were searched through April 2022 to identify propensity score matched (PSM) studies or randomized controlled trial (RCT) which compared outcomes following SAVR among three incisional approaches: FS, MS, or RMT. The network analysis was performed to compare these approaches with random effects model. Mid‐term mortality was defined as 1‐year mortality. Results A total of 42 studies met the inclusion criteria enrolling 14,925 patients. RCT and PSM were performed in 13 and 29 studies, respectively. The operative mortality was significantly lower with MS compared to FS (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.41–0.90, p = .01, I2 = 25.8%) or RMT (RR: 0.51, 95% CI: 0.27–0.97, p = .03, I2 = 25.8%). RMT had significantly higher risk of reoperation for bleeding compared to MS (RR: 1.65, 95% CI: 1.18–2.30, p = .003, I2 = 0%). Hospital length of stay was significantly shorter with MS compared to FS (mean difference: −0.89 days, 95% CI: −1.58 to −0.2, p = .01, I2 = 95.5%) while it was equivocal between FS and RMT. The mid‐term mortality was similar among the three approaches. Conclusions While mid‐term mortality was comparable among approaches, MS may be a safe and potentially more effective approach than FS and RMT for SAVR in the short term.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 70%

Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

Ogami

Yokoyama

Takagi

et al. 2022

Journal of Cardiac Surgery

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“…1-, 3- and/or 6-month) QoL outcomes. Hypothetically, shorter-term differences could be present between the surgical approaches, as was demonstrated by the UK Mini trial [ 4 , 17 ], although conflicting evidence exists in related cardiac surgical procedures [ 25 ]. Furthermore, echocardiographic and additional clinical follow-up is not incorporated in this registry.…”

Section: Discussionmentioning

confidence: 99%

One-year postprocedural quality of life following mitral valve surgery: data from The Netherlands Heart Registration

Heuts,

Olsthoorn,

Houterman

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES The aim of surgical treatment of mitral valve disease is to reverse heart failure and to restore life expectancy and quality of life (QoL). In mitral valve surgery, QoL has not been studied extensively, especially regarding the surgical approach. The current study aimed to evaluate QoL after mitral valve surgery through full sternotomy and a minimally invasive approach (minimally invasive mitral valve surgery). METHODS All patients undergoing mitral valve surgery between 2013 and 2018 through sternotomy or a minimally invasive mitral valve surgery approach (right anterolateral mini-thoracotomy, sternal-sparing), with or without concomitant tricuspid valve surgery, surgical ablation or atrial septal defect closure were eligible for inclusion in this multicentre nationwide registry in the Netherlands. QoL was measured using the 12- and 36-item short form surveys, before surgery and postoperatively at 1 year. Independent predictors for loss of QoL were evaluated. RESULTS A total of 485 patients were included (full sternotomy: n = 276, and minimally invasive mitral valve surgery: n = 209). Overall, patients experienced a significant increase in physical component score [56 (42–75) vs 74 (57–88), P < 0.001] and mental component score at 1 year [63 (52–74) vs 70 (59–86), P < 0.001]. Baseline QoL scores and new onset of atrial arrhythmia were independently associated with a clinically relevant reduction in physical and mental QoL. CONCLUSIONS Mitral valve surgery is associated with significant improvement in physical and mental QoL. Baseline QoL scores and new onset of atrial arrhythmia are associated with a clinically relevant reduction in postoperative QoL.

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“…Хірургічні втручання, особливо складні, такі, як КХВ, вимагають оцінки не лише суто клінічних критеріїв ефективності, а й комплексного оцінювання функціонального стану пацієнтів, які перенесли хірургічні операції [6,7]. Одним з найбільш вагомих інструментів у такій оцінці є методи, які враховують власне сприйняття пацієнтом свого функціонального стану та ЯЖ, що сьогодні розглядається в якості одного з провідних критеріїв ефективності лікування, актуального стану фізичного та психічного здоров'я пацієнта, а та-кож перспектив відновлення здоров'я та нормального функціонування попри певні технічні і методологічні обмеження [8].…”

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Quality of Life and Social Functioning of Patients After Cardiosurgical Interventions

Mankovskyi

2022

FMEP

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The objective: to study the quality of life (QOL) and social functioning of patients who underwent cardiosurgery intervention (CSI) with the use of artificial circulation (AR) in the postoperative period, to determine and improve the system for further medical, psychological and social rehabilitation. Materials and methods. 700 patients who underwent CSI with the use of AR were treated at the Heart Institute of the Ministry of Health of Ukraine. 86 patients had cerebral infarction (CI), 217 patients with signs of postoperative encephalopathy, and 504 patients with signs of cognitive dysfunction. The level of QOL and social functioning in patients with this pathology was analyzed. Statistical analysis of differences in the quantitative values of indicators was performed using the nonparametric Mann-Whitney test. Results. It was found that patients after CSI had generally low levels of QOL in all fields, namely in the indicators of psychological (emotional) well-being, general perception of life, ability to work, physical well-being, personal realization, selfcare and independence; interpersonal interaction. The presence of ischemic and neurological complications in patients after CSI significantly reduces the QOL indicators in all areas, with differences in the quantitative values of such patients statistically significant (p<0,01) compared to the groups of patients without such complications. The most significant deterioration of QOL is found in patients with cerebral infarction in the postoperative period, slightly less significant – in patients with signs of postoperative encephalopathy, and the smallest changes – in patients with signs of cognitive dysfunction. Conclusions. The main task of modern cardiac surgery is not only to save the patient from death, but also to improve the quality of life (QOL). At the same time, patients after cardiac surgery are at risk of developing ischemic, neurological complications that significantly reduce QOL in all areas of life. That is why it is necessary to take into account the findings of the study in the development of treatment and rehabilitation programs and preventive measures for such patients.

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Postoperative Quality of Life After Full-sternotomy and Ministernotomy Aortic Valve Replacement

Cited by 4 publications

References 26 publications

Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

One-year postprocedural quality of life following mitral valve surgery: data from The Netherlands Heart Registration

Quality of Life and Social Functioning of Patients After Cardiosurgical Interventions

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