(P247) A PROM-CENTRIC PROSPECTIVE STUDY TO EXPLORE THE CLINICAL ADVANTAGES OF MINIMALLY INVASIVE AORTIC VALVE SURGERY

Background: Minimally invasive, sternal sparing, aortic valve replacement via right anterior mini-thoracotomy (MIS-AVR) continues to gain interest due to purported accelerated postoperative recovery without compromising patient safety. However, there remains a paucity of robust prospective data. Patient Reported Outcomes Measures (PROMs) quantify key aspects of the postoperative experience including quality of life and physical function. We have previously developed a PROM-centric study model that evaluates a patient’s quality of life and physical function throughout their postoperative recovery after cardiac surgery. Herein, we employ this PROM-centric design to characterize the postoperative recovery of patients receiving MIS-AVR.

METHODS AND RESULTS: A single-center, prospective, cohort study evaluated postoperative recovery for consenting patients receiving isolated MIS-AVR via right anterior minithoracotomy with femoral cannulation (N=13). Adverse events and PROMS are reported to week 6. PROMs include quality of life (EQ-5D; EuroQuol), and physical disability (Health Assessment Questionnaire [HAQ]), which were collected at preoperative baseline and predetermined postoperative timepoints.
Table 1 shows patient demographics, operative data, and adverse events at 6 weeks; during which there were no incidence of death, stroke, or return to operating room. Figure 1 plots EQ5D indices (Quality of Life) for individual patients, and displays the mean trend compared with the mean preoperative baseline. The mean trend reached and exceeded mean baseline quality of life before the week 2 timepoint (0.85 vs 0.82; Week 2 vs. Baseline EQ5D Index). At week 2, patients’ HAQ (Physical Function) indices were compared with their baseline, demonstrating that 69% of patients returned to baseline physical function, and 8% were within the pre-determined clinically meaningful minimal difference (CMMD) threshold.

Conclusion: This cohort study validates the adaptation of our PROM-centric study model to MIS-AVR via right anterior minithoracotomy. Along with demonstrating safety, this model leverages PROMs to characterize postoperative recovery, which is important to patients and their long-term care teams. Furthermore this study may provide insight into the potential advantages of minimally invasive cardiac surgery, as there was a mean recovery to baseline quality of life and majority recovery to baseline physical function by postoperative week 2. This finding may prompt future studies to focus on earlier postoperative timepoints when comparing MIS-AVR to conventional approaches, as patients may resume leisure and work activities earlier following surgery. We intend to grow this cohort and are actively recruiting patients receiving isolated AVR via median sternotomy for a future comparison of similar design.