Five-Year Quality of Life Outcome from a Randomized Controlled Trial Comparing Aortic Valve Replacement through Upper Hemisternotomy and Full Median Sternotomy

OBJECTIVES The impact of minimally invasive surgical aortic valve replacement on long-term quality of life is uncertain. This randomized controlled trial compared quality of life five years after surgical aortic valve replacement through upper hemisternotomy or full median sternotomy. METHODS Patients undergoing surgical aortic valve replacement were randomized to upper hemisternotomy or full median sternotomy. The primary outcome was postoperative cardiac-specific quality of life during five years, assessed by the Kansas City Cardiomyopathy Questionnaire physical limitations domain. Secondary outcomes include survival, other quality of life domains, and factors associated with declined quality of life between one and five years. RESULTS Surgical aortic valve replacement via upper hemisternotomy resulted in better quality of life as indicated by more favourable physical limitation and total symptoms scores (estimated mean difference (95% confidence interval) respectively -1.89 (-2.93 to -0.85; p-value = <0.001) and 2.96 (-4.71 to -1.22; p-value = 0.016). Quality of life improvement persisted for five years, despite a decline after one year postoperative. Age and valve size smaller than or equal to 21 were independent predictors of decline in physical functioning, while full median sternotomy independently predicted declined total symptoms score. Five-year survival was 91.9% and similar between approaches (p-value = 0.417). CONCLUSIONS Minimally invasive surgical aortic valve replacement was associated with a modest but statistically significant improvement in cardiac-specific quality of life over five years compared to median sternotomy, driven by earlier recovery, with comparable outcomes at five years. Full median sternotomy independently predicted decline in quality of life demonstrated by decreased total symptom scores.