Patient-reported outcomes: How to advance the minimally invasive debate

Percy, Edward; Hirji, Sameer; Kaneko, Tsuyoshi; Pelletier, Marc

doi:10.1016/j.jtcvs.2019.01.052

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Critics of minimally invasive SAVR techniques point to increased complexity and prolonged operative times, without reproducible improvements in morbidity and mortality [ 27 , 28 ]. Our study indicates UHS can be technically more challenging, demonstrated by prolonged operative time and conversion rate.…”

Section: Discussionmentioning

confidence: 99%

Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial

Klop,

Van Putte,

Kloppenburg

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Surgical aortic valve replacement through conventional sternotomy yields excellent results. Minimally invasive techniques are deemed equally safe and serve as a viable and less traumatic alternative. However, it is unclear how both surgical techniques affect patient reported outcomes. The objective of this trial is to compare postoperative cardiac-related quality of life and postoperative pain after upper hemisternotomy and conventional surgical aortic valve replacement. METHODS In this single centre, open-label, investigator-initiated randomized clinical trial, patients were randomized to upper hemisternotomy or conventional full median sternotomy. Patients unable to undergo randomization were monitored prospectively (registry group). Primary outcome was cardiac specific quality of life, measured with the Kansas City Cardiomyopathy Questionnaire up to one year postoperatively. RESULTS Patients undergoing upper hemisternotomy had a significantly higher physical limitation domain score across all post-operative time points than patients undergoing conventional surgical aortic valve replacement (estimated mean difference 2.12 points; p = 0.014). Patients undergoing upper hemisternotomy were more likely to have a pain score <30 the first two days postoperatively than patients undergoing conventional surgical aortic valve replacement (Odds Ratio 2.63; p = 0.007). This was associated with reduced opioid analgesic intake. Postoperative surgical outcome did not differ between both groups. CONCLUSIONS Surgical aortic valve replacement through both conventional sternotomy and upper hemisternotomy resulted in clinically similar and important improvements in quality of life, with a small advantage for upper hemisternotomy, while there was no compromise in safety.

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Section: Discussionmentioning

confidence: 99%

Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial

Klop,

Van Putte,

Kloppenburg

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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show abstract

Section: Discussionmentioning

confidence: 99%

“…While an assessment of these patient-reported outcomes was beyond the scope of the present study, we believe that outcome measures such as pain and return to normal activity will have increasing value and should be pursued in future MIS research. 29 This research is subject to the inherent limitations of a singlecenter, retrospective study design. Given that the choice of approach was primarily a surgeon-specific decision, it was not possible to fully eliminate patient selection bias.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Right Minithoracotomy Versus Hemisternotomy for Mitral Valve Repair

Percy

Hirji

Yazdchi

et al. 2020

Innovations�(Phila)

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Objective Minimally invasive mitral valve repair has been increasingly adopted. Right minithoracotomy (RT) and lower hemisternotomy (HS) have each been associated with improved short-term outcomes; however, these approaches have not been directly compared to each other. The aim of this study was to compare long-term survival and durability of 2 minimally invasive approaches to mitral repair. Methods We retrospectively identified all isolated mitral repairs performed via RT or HS between October 1997 and June 2018; 100 RT cases and 719 HS cases were included. Outcomes of interest were postoperative complications, long-term survival, and freedom from mitral reoperation. A Cox proportional hazard model was used to compare RT and HS to a reference cohort of full-sternotomy cases. Total observation time was 9,901 patient-years and mean follow-up time was 12.2 years. Results Mean age was 58±12 years in the RT group and 56±13 years in the HS group ( P = 0.2). The RT group had longer bypass (143 minutes vs. 112 minutes; P < 0.001) and cross-clamp times (99 minutes vs. 78 minutes; P < 0.001) compared with the HS group. There were no differences in operative mortality or 30-day outcomes. Survival at 5, 10, and 15 years was 99% (96-100), 92% (85-100), and 69% (30-100) in the RT group and 98% (97-99), 92% (90-94), and 89% (86-92) for HS ( P < 0.9). There were no differences in risk-adjusted survival between RT, HS and full sternotomy. No long-term mitral reoperations occurred in the RT group and 8 (1%) occurred in the HS group ( P < 0.50). Conclusions Minimally invasive mitral valve repair can be performed safely through RT or HS with excellent survival and durability at 15 years.

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“…To others, the goal of reduced pain and perceived earlier return to full functionality is the dominant motivator. As with all areas of medicine, the patient perspective must be an important consideration (6)(7)(8). There is little doubt that these are benefits to MICS if performed safely by experienced centres and offered to appropriate patients.…”

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confidence: 99%

Minimally invasive cardiac surgery—a Fad or the Future?

Ali¹,

Abu‐Omar²

2021

J Thorac Dis

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Editorial on Minimally Invasive Cardiac SurgeryMinimally invasive cardiac surgery-a Fad or the Future?Over recent years there has been significant progress in the development and adoption of minimally invasive techniques in cardiac surgery (1). In thoracic surgery, video-assisted thoracoscopic surgery (VATS) has become the norm (2). In cardiac surgery, the median sternotomy has been, and remains, the trusted, well-established and gold standard access route for many decades. However, perhaps motivated by developments in other surgical specialties, there has been a slow movement towards minimally invasive cardiac surgery (3). To support this movement, a professional society emerged: the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS).

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Patient-reported outcomes: How to advance the minimally invasive debate

Cited by 4 publications

References 8 publications

Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial

Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial

Long-Term Outcomes of Right Minithoracotomy Versus Hemisternotomy for Mitral Valve Repair

Minimally invasive cardiac surgery—a Fad or the Future?

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