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Ann Card Anaesth. 2019 Jul-Sep;22(3):239-245. doi: 10.4103/aca.ACA_77_18.

Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement.

Author information

1
Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA.
2
Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA; Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
3
Department of Surgery, Tufts Medical Center, Boston, MA, USA.
4
Cardiovascular and Thoracic Section Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA.
5
Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

Objective:

Chronic postthoracotomy pain (CPTP) is a persistent, occasionally debilitating pain lasting >2 months following thoracic surgery. This study investigates for the first time the prevalence and clinical impact of CPTP in patients who have undergone a transapical transcatheter aortic valve replacement (TA-TAVR).

Design:

This was a single-institution, prospective observational survey and a retrospective chart review.

Setting:

The study was conducted in the University Hospital.

Participants:

Patients.

Materials and Methods:

A survey of 131 participants with either a previous TA TAVR or transfemoral (TF) TAVR procedure was completed. A telephone interview was conducted at least 2 months following TAVR; participants were asked to describe their pain using the Short-Form McGill Pain Questionnaire.

Measurements and Main Results:

Odds ratio (OR) was calculated using the proportions of questionnaire responders reporting "sensory" descriptors in the TA-TAVR versus the TF-TAVR groups. Results were then compared to individual Kansas City Cardiomyopathy Questionnaire (KCCQ12) scores and 5-min walk test (5MWT) distances. A total of 119 participants were reviewed (63 TF, 56 TA). Among TA-TAVR questionnaire responders (n = 16), CPTP was found in 64.3% of participants for an average duration of 20.5-month postprocedure (OR = 10, [confidence interval (CI) 95% 1.91-52.5];P = 0.003). TA-TAVR patients identified with CPTP had significant reductions in 5MWT distances (-2.22 m vs. 0.92 m [P = 0.04]) as well as trend toward significance in negative change of KCCQ12 scores OR = 18.82 (CI 95% 0.85-414.99;P = 0.06) compared to those without CPTP.

Conclusions:

CPTP occurs in patients undergoing TA-TAVR and is possibly associated with a decline quality of life and overall function.

KEYWORDS:

Aortic valve replacement; chronic pain; thoracotomy; transapical transcatheter aortic valve replacement

PMID:
31274483
DOI:
10.4103/aca.ACA_77_18

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