Assessment Of Pain And Quality Of Life In Patients Undergoing Minimally Invasive Aortic Cardiac Surgery
Serge Sicouri, MD1, Vishal Shah, DO1, Cinthia Orlov, MD1, Aikaterini Dedeilia, MD1, Meghan Buckley, MS1, Sharon L. Larson, PhD1, Brian McAnany, MPH1, Nicholas S. Imperato, BS1, Shamayel Alroomi1, Konstadinos A. Plestis, MD2.
1Lankenau Institute for Medical Research, Wynnewood, PA, USA, 2Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Background: Minimally invasive cardiac surgery (MICS) has been shown to reduce surgical trauma, and potentially reduce post-operative (Postop) pain and improve quality of life (QoL). The aim of the study is to determine the effects of MICS on Postop pain, QoL (SF-36) and hospital and depression scale (HADs) in patients undergoing ministernotomy aortic valve and aortic aneurysm surgery. Methods: This is a prospective, single-center cohort study in patients undergoing ministernotomy (“J” type exiting the right 3rd or 4th intercostal space) for aortic valve or aortic aneurysm replacement from August 1, 2018 to August 1, 2019. Visual analysis scale of pain (VAS Pain), SF-36 (QoL parameters), and HADs questionnaires were used before surgery, prior to discharge (Pain questionnaire) and at 1 and 3 months after discharge. Also, we compare the scores of patients who had symptoms before surgery compared to patients who were asymptomatic. Changes in average scores from baseline are presented as adjusted mean differences (time i - baseline) (standard error). Results: Twenty-four patients, 16 males and 8 females, mean age 61.6+9.0 for males and 66.0 +8.8 for females, were included. Fifteen patients underwent aortic valve replacement (AVR), 4 aortic root replacement, and 5 ascending aortic aneurysm surgery. At the time of discharge, the average Pain score (Figure 1, A) was significantly lower than postoperative day 1 (-2.4 (0.5); p=<0.001), and by 1 month the Pain scores were not significantly different from baseline (0.7 (0.5); p=0.194). HADs scores (Figure 1, B) show that depression and anxiety were significantly decreased by 3 months (-1.7 (0.7); p=0.001 and -2.5 (0.7); p= 0.009). SF-36 (Figure 1, C-D) scores show no changes or increase in scores in 7 of 8 categories at 1 month and a significant increase in all categories but "Role Limitations Due to Physical Health" at 3 months indicating significant improvement in the QoL parameters compared to baseline. No significant differences were observed at 3 months between the symptomatic and asymptomatic patients in their VAS Pain, SF-36, and HADs scores. Conclusions: Following MICS in this group of patients, VAS Pain, HADs, and 7 of 8 SF-36 scores returned to baseline or improved compared to baseline at 1 month and all scores improved compared to baseline at 3 months. Further studies are needed to evaluate the impact of MICS in QoL. 
LEGEND: Figure 1. Pain and QoL scores taken at baseline, 1-, and 3-months Postop. All data presented as mean (standard error). (A) VAS Pain scores. Lower score indicates lower levels of pain. (B) HADs scores. Lower scores indicate lower levels of anxiety and depression. (C-D). SF-36 subscale scores. Higher scores represent a more favorable health state.
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