Marco Moscarelli1, Roberto Lorusso2, Yusuf Abdullahi3, Egidio Varone4, Marco Marotta4, Marco Solinas4, Roberto Casula3, Alessandra Parlanti4, Giuseppe Speziale5, Khalil Fattouch5, Thanos Athanasiou3. 1. Imperial College, National Heart and Lung Institute, London, UK; Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy. Electronic address: m.moscarelli@imperial.ac.uk. 2. Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. 3. Imperial College, National Heart and Lung Institute, London, UK. 4. Pasquinucci Heart Hospital, Massa, Italy. 5. Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy.
Abstract
AIM: The aim of this study was to compare minimally invasive surgery (MI) and median sternotomy (MS) in terms of post-procedure health-related quality of life (HRQoL) and functional outcome. METHOD: We conducted a multicentre prospective cohort study that enrolled patients from January 2015 until February 2017. Combined cardiac procedures were performed with MS and isolated valve procedures with either MS or MI, depending on patient preference and surgeon experience. HRQoL was measured using the five-level version of the EQ-5D (EQ-5D-5L) and physical activity before and after surgery was evaluated using a wearable accelerometer. Activity patterns and intensity recorded by the accelerometer in each period were classified as "sedentary", "light physical activity", "moderate physical activity", and "vigorous physical activity" for each patient. We also conducted a sub-analysis of frail patients in each group, as identified by the Reported Edmonton Frail Scale (>10 points). Patients were followed for 1 year. RESULTS: The study included 100 consecutive patients who underwent MI (n=50) or MS (n=50) during the study period. Patients in the MI group showed a faster recovery of physical activity in the immediate postoperative period and superior HRQoL in the first 3 months (both p<0.001) versus the MS group. Differences between the MI and MS group were indistinguishable over a longer follow-up. A similar correlation was observed in the frailty subanalysis. Overall, the MS group had a higher cumulative incidence of events than the MI group (p<0.001). CONCLUSIONS: Compared to conventional MS, MI was associated with better HRQoL and early functional outcome, even in frail patients.
AIM: The aim of this study was to compare minimally invasive surgery (MI) and median sternotomy (MS) in terms of post-procedure health-related quality of life (HRQoL) and functional outcome. METHOD: We conducted a multicentre prospective cohort study that enrolled patients from January 2015 until February 2017. Combined cardiac procedures were performed with MS and isolated valve procedures with either MS or MI, depending on patient preference and surgeon experience. HRQoL was measured using the five-level version of the EQ-5D (EQ-5D-5L) and physical activity before and after surgery was evaluated using a wearable accelerometer. Activity patterns and intensity recorded by the accelerometer in each period were classified as "sedentary", "light physical activity", "moderate physical activity", and "vigorous physical activity" for each patient. We also conducted a sub-analysis of frail patients in each group, as identified by the Reported Edmonton Frail Scale (>10 points). Patients were followed for 1 year. RESULTS: The study included 100 consecutive patients who underwent MI (n=50) or MS (n=50) during the study period. Patients in the MI group showed a faster recovery of physical activity in the immediate postoperative period and superior HRQoL in the first 3 months (both p<0.001) versus the MS group. Differences between the MI and MS group were indistinguishable over a longer follow-up. A similar correlation was observed in the frailty subanalysis. Overall, the MS group had a higher cumulative incidence of events than the MI group (p<0.001). CONCLUSIONS: Compared to conventional MS, MI was associated with better HRQoL and early functional outcome, even in frail patients.
Authors: Christopher D Roche; Gautam R Iyer; Minh H Nguyen; Sohaima Mabroora; Anthony Dome; Kareem Sakr; Rohan Pawar; Vincent Lee; Christopher C Wilson; Carmine Gentile Journal: Front Robot AI Date: 2022-01-18