RESUMEN
Aim To determine the effect of minimally invasive interventions on the quality of life (QoL), pain syndrome, and cosmetic effect in patients with a pathology of chest aorta as compared with a group of traditional access.Material and methods From 2016 through 2020, 77 of 226 (34%) patients with an aneurysm in the proximal chest aorta and mini-sternotomy were prospectively selected starting from 2017. To evaluate differences between the effects of mini-sternotomy and the traditional access on QoL and pain syndrome a control group of patients with full sternotomy (n=77) was formed using pseudorandomization. Intergroup comparison of QoL, pain syndrome, and cosmetic parameters was performed at various time points.Results Mini-sternotomy provided a decrease in pain syndrome both during the early period (day 3), and during movements upon discharge. Also, mini-sternotomy decreased the duration of stay in the hospital compared to full sternotomy (8.1±2.1 vs. 8.9±2.5âdays, respectively; Ñ>0.0331). A more frequent use of analgesics by patients with full sternotomy was noted. Mini-sternotomy was associated with a faster recovery of most QoL parameters according to the SF-36 questionnaire at one year after surgery. The questionnaire included summarizing parameters of physical and mental health components (Physical Health Component, Physical Health (PH): 54.3±11.9 vs. 58.2±8.2, respectively; p=0.046; Mental Health Component, Mental Health (MH): 53.8±6.8 vs. 57.8±9.5, respectively; p=0.013). In addition, patients with minimal access showed higher values of the cosmetic effect by a 5-score scale (4.08±0.8 vs. 4.39±0.8, respectively; p=0.049) and a greater interest to having a minimal access surgery.Conclusion Mini-sternotomy beneficially influences the pain syndrome, cosmetic outcome, and QoL and provides a shorter duration of rehabilitation and a sooner return to work and everyday life compared to full sternotomy.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Calidad de Vida , Humanos , Aorta Torácica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Resultado del Tratamiento , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Dolor , Estudios RetrospectivosRESUMEN
Presented herein is a clinical case report concerning the use of a hybrid technique in stagewise surgical management of a patient with distal dissection and an aneurysm of the thoracoabdominal portion of the aorta. The patient at high risk with the connective tissue dysplasia syndrome had a past medical history of prosthetic repair of the descending thoracic aorta with type-1 haemodynamic correction. Three years later, the findings of computed tomography demonstrated fenestration in the area of the distal anastomosis, a patent false channel, and an increase in the diameter of the unoperated thoracoabdominal portion of the aorta. The first stage consisted in performing prosthetic repair of the infrarenal portion of the aorta by means of the multibranched Coselli thoracoabdominal graft, followed by 'switching' the visceral branches into the formed prosthesis. 14 days later, the second stage included stenting of the dilated suprarenal portion of the aorta. The patient was discharged on day 9 after the second stage of the operation. This clinical case report demonstrates that a hybrid method of treatment may by an alternative to an open operation in high risk surgical patients presenting with severe concomitant somatic pathology.