Psychological Effects of Skin Incision Size in Minimally Invasive Valve Surgery Patients

Abstract

Objective Clinical benefits of minimally invasive cardiac valve surgery (MIVS) have been reported. Improved postoperative mental status was never analyzed with dedicated psychological tests. In the present study we intend to investigate potential benefits of MIVS for patient psychological well-being, with special attention to the relevance of the patient perception of the chest surgical scar, of the self body image and cosmetic aspects. Methods Between 2016 and 2017, 87 eligible patients, age 66.5 ± 14.5 years, operated on for heart valve surgery, underwent either conventional full sternotomy (CS; n = 48) or MIVS by V-shape hemi-sternotomy approach ( n = 39). Before selection of the surgical approach, patients had undergone preoperative evaluation of their psychological status using Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory Form Y (STAI-Y), and EuroQol-5D (EQ-5D) psychological tests. Six months postoperatively, patients filled in dedicated questionnaires to assess their psychological status, quality of life, and subjective perception, thus repeating the above-mentioned tests and adding the Body Image Questionnaire (BIQ) and Patient and Observer Scar Assessment Scale (POSAS) v2.0 tests for scar-healing process evaluation. Results No patient died during the study.The 4 post-test scales of psychological well-being (BDI-II P = 0.04, STAI-Y P = 0.04, 2 indices of EQ-5D P = 0.03, P = 0.01) showed significant differences between the MIVS group and CS group, with MIVS-small incision patients having lower level of depression and anxiety symptoms and better quality of life. Mean score differences of scar perception (BIQ and POSAS v2.0) were significant, with MIVS patients having evaluated the scar quality significantly better than CS patients. Conclusions MIVS appears associated with significant esthetical and related psychological benefits, as documented by technical tests. These findings should be considered when selecting the most appropriate technique for heart valve surgery.

Propensity-score matched comparison between minimally invasive and conventional aortic valve replacement

“…Body image and self-esteem metrics have been shown to be impaired after conventional cardiac surgery ( 12 ). In contrast, minimally invasive incisions have been shown to lead to psychological benefits and less anxiety symptoms due to superior esthetical wound healing and scar size ( 13 ). Another, albeit less frequently recognized, benefit of minimally invasive approaches in cardiac surgery is that future reoperations are less cumbersome and are associated with less bleeding.…”

Patient-Reported Outcomes in Cardiovascular Trials

“…30 One cardiac clinical trial strategy is to evaluate minimally invasive versus conventional techniques, hypothesizing that smaller incisions may reduce post-surgical distress about body image. 31,32 After cardiac surgery, a patient's altered body image perception can put them at higher risk of depression and anxiety. 33 Body disfigurement associated with scars at multiple surgical sites can significantly alter body image perception resulting in traumatic psychological effects, low self-esteem, and impair social interactions and functioning in both adult and pediatric populations.…”

“…33 Body disfigurement associated with scars at multiple surgical sites can significantly alter body image perception resulting in traumatic psychological effects, low self-esteem, and impair social interactions and functioning in both adult and pediatric populations. 32,34 Specific body image outcome assessments include the Body Image Questionnaire (BIQ), Patient and Observer Scar Assessment Scale (POSAS) v2.0, 31 and the Multidimensional Body Self Relations Questionnaire (MBSRQ). 35 In a study with CABG patients, a cardiac rehabilitation intervention was associated with better physical function and MBSRQ scores, indicating better body image postoperatively.…”

Analogies between medusa and single port surgery in gastroenterology and hepatology: A review

“…At first glance, this improved cosmesis would seem to be insignificant in light of the bulk of unsolved problems bothering surgical science. However, esthetic aspects undoubtedly exert an important impact on quality of life[ 18 ] and are underestimated by surgeons who focus solely on overall and disease-free survival.…”