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Quality Of Life And Psychoemotional Health After Robotic And Conventional Mitral Valve Replacement: A Comparative Study
Lokman Yalçin, Burak Ersoy, Hasan Ardal, Mehmet Emin Öner, Abdülkerim Buğra, Yasin Ay.
Istanbul Mehmet Akif Ersoy Cardiothoracic and Vascular Surgery Training and Research Hospital, Istanbul, Turkey.
BACKGROUND: Robotic techniques have emerged as a transformative approach in mitral valve replacement (MVR) surgery, offering minimally invasive solutions compared to conventional methods. While their anatomical and technical advantages have been extensively documented, the mid-term impact of robotic approaches on quality of life (QoL) and psychoemotional well-being remains inadequately explored. This study seeks to bridge this gap by providing a comparative evaluation of mid-term QoL and psychoemotional outcomes in patients undergoing robotic versus conventional mitral valve replacement surgery.
METHODS:A total of 399 patients who underwent isolated MVR between 2019 and 2023 were included in the study. Propensity score matching (PSM) was used to pair 97 robotic and 97 conventional MVR patients. Mid-term outcomes were assessed using the EQ-5D-5L, Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Depression (HADS-D) subscales, and the Post-Traumatic Stress Disorder (PTSD) scale. Relationships between demographic, echocardiographic, and clinical parameters, such as age, gender, body surface area (BSA), pulmonary artery pressure (PAP), left ventricular dimensions, comorbidities (e.g., diabetes, pulmonary disease), and operative variables (e.g., cross-clamp time), and outcome measures were analyzed.
RESULTS:There was no significant difference in EQ-5D-5L scores between robotic and conventional MVR groups, with no notable differences observed in mid-term outcomes regarding daily activities such as social engagement and mobilization. However, VAS scores indicated a better perception of personal health in the robotic group, while factors such as pulmonary disease, PAP, diabetes, and advanced age were negatively correlated with QoL perceptions. HADS-A scores were significantly influenced by the surgical approach, BSA, NYHA class, and pulmonary disease, with anxiety levels being lower in the robotic group. Similarly, HADS-D scores were lower in the robotic group, while pulmonary disease was identified as a key factor exacerbating depression levels. Although there was no significant difference in PTSD scores between the groups, a negative correlation was observed between low BSA and PTSD symptoms.
CONCLUSIONS:Robotic MVR demonstrated superior mid-term QoL and psychoemotional well-being outcomes, particularly in anxiety, depression, and personal health perception, compared to conventional methods. These findings highlight the significance of minimally invasive techniques in improving patient-centered outcomes beyond short-term surgical success. Further research is warranted to explore the mechanisms underlying these advantages and their implications for surgical decision-making.
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