Original article
Adult cardiac
Quality of Life After Early Mitral Valve Repair Using Conventional and Robotic Approaches

https://doi.org/10.1016/j.athoracsur.2011.11.062Get rights and content

Background

Early mitral valve (MV) repair of degenerative mitral regurgitation is associated with superior clinical outcomes compared with prosthetic replacement and restores normal life expectancy, even in those without symptoms. Although current guidelines recommend prompt referral for effective MV repair in those with severe mitral regurgitation, some are reluctant to pursue early correction due to the perception that short-term quality of life (QOL) may be adversely affected by the operation.

Methods

Between January 2008 and November 2009, 202 patients underwent conventional transsternotomy or minimally invasive port-access robot-assisted MV repair, with or without patent foramen ovale closure or left Maze, and were mailed a postsurgical QOL survey.

Results

Unadjusted QOL scores for patients undergoing MV repair were excellent early after the operation using both approaches. Robotic repair was associated with slightly improved scores on the Duke Activity Status Index, the Short Form-12 Item Health Survey Physical domain, and the Linear Analogue Self-Assessment frequency of chest pain and fatigue indices during the first postoperative year; however, differences between treatment groups became indistinguishable after 1 year. Robotic repair patients returned to work slightly quicker (median, 33 vs 54 days, p < 0.001).

Conclusions

Functional QOL outcomes within the first 2 years after early MV repair are excellent using open and robotic platforms. A robotic approach may be associated with slightly improved early QOL and return to employment-based activities. These results may have implications regarding future evolution of clinical guidelines and economic health care policy.

Section snippets

Patients and Methods

This study was approved by the Mayo Clinic Institutional Review Board.

Patient Characteristics

Of 90 eligible patients who underwent robot-assisted MV repair, 69 returned completed surveys, and of 112 eligible patients who had undergone conventional transsternotomy MV repair, 72 patients completed surveys after three mailings, with an overall response rate of 70%. The demographic and clinical characteristics of respondents are reported in Table 1. Although individual disease comorbidities were similar between groups, cumulative age-weighted Charlson scores were different, with the open

Comment

We used validated assessment tools to examine postoperative QOL indices among asymptomatic or minimally symptomatic patients undergoing isolated MV repair for degenerative leaflet prolapse, employing identical repair techniques but different incisions. We found that patients report excellent recovery of QOL very early after mitral valve repair. We further stratified outcomes between patients undergoing robot-assisted vs conventional transsternotomy MV repair to determine whether surgical

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