Analysis of Postoperative Quality of Life in Patients With Acute Type A Aortic Dissection After Extensive Arch Repair via Partial Upper Sternotomy.

Abstract

Background: This study aimed to compare health-related quality of life (HRQoL) in patients with acute type A aortic dissection (AAAD) who underwent extensive arch repair via partial upper sternotomy (PUS) or full median sternotomy (FS).

Methods: Data were collected from 112 patients with AAAD who were divided into two groups based on the surgical approach. HRQoL was assessed using the MOS 36-item Short-Form Health Survey (SF-36) at discharge (AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12), whereas anxiety symptoms were evaluated using the Spielberger State-Trait Anxiety Inventory state and trait scores (STAI-S and STAI-T) only at POM3.

Results: The PUS group had a numerically lower rate of sternal wound complications than the FS group (1.8% vs. 8.8%; p = 0.206), with no significant differences in other in-hospital events. Overall, 112 patients completed the 1-year follow-up. Repeated-measures analyses showed progressive improvement in SF-36 scores from discharge to POM12 in both groups. Compared with the FS group, the PUS group reported better early postoperative HRQoL in selected domains, including role physical, bodily pain, role emotional, and mental health; however, these between-group differences were attenuated at POM12. At POM3, the STAI-S and STAI-T scores were significantly higher in the FS group than in the PUS group.

Conclusions: Partial upper sternotomy for extensive arch repair was feasible and was not associated with an apparent increase in perioperative adverse events. Compared with full sternotomy, PUS was associated with less reported pain, lower psychological burden, and better early postoperative HRQoL in selected patients with AAAD.