Patient Attitudes to Sternotomy and Thoracotomy Scars[*]

Abstract

Background: There are no data comparing patient attitudes to sternotomy and thoracotomy scars following surgery for congenital heart disease (CHD). Methods: Two hundred and one patients with a scar from CHD surgery (105 sternotomy, 36 thoracotomy, and 60 both scars) had a structured interview to explore attitudes to their scar. Results: Comparable proportions of each group reported that they did not like or hated their scar (23/105 [22 %] sternotomy, 9/36 [25 %] thoracotomy, 17/60 [28 %] both scars). Significantly more patients stated that they where embarrassed by and/or their choice of clothing was affected by a thoracotomy scar (20/36, 56 %) than those with a sternotomy scar (36/105, 34 %), p = 0.04. This was also seen when comparing sternotomy alone with both scars (36/105 [34 %] vs. 34/60 [57 %], p = 0.008). Conclusions: Adults who have undergone surgery for CHD are more likely to have a negative attitude to a thoracotomy than a sternotomy scar. Before a change in surgical approach is considered based on patient preferences, the acceptability and psychological impact of the different scars following surgery needs formal study.

Congenital heart disease - scar - thoracotomy - sternotomy

References

• 1 Wren C, O'Sullivan J J. Survival with congenital heart disease and need for follow-up in adult life.  Heart. 2001;  85 438-443
• 2 Celermajer D S, Deanfield J E. Adults with congenital heart disease.  BMJ. 1991;  303 1413-1414
• 3 van Rijen E HM, Utens E MWJ, Roos-Hesselink J W. et al . Psychosocial functioning of the adult with congenital heart disease: a 20 - 33 years follow-up.  Eur Heart J. 2003;  24 673-683
• 4 Lane D A, Lip G YH, Millane T A. Quality of life in adults with congenital heart disease.  Heart. 2002;  88 71-75
• 5 Van Doorn C, Yates R, Tunstill A, Elliot M. Quality of life in children following mitral valve replacement.  Heart. 2000;  84 643-647
• 6 Ternestedt B M, Wall K, Oddsson H, Reisenfeld T, Groth I, Schollin J. Quality of life 20 and 30 years after surgery in patients operated on for tetralogy of fallot and for atrial septal defect.  Pediatr Cardiol. 2001;  22 128-132
• 7 Kokkonen J, Paavilainen T. Social adaptation of young adults with congenital heart disease.  International J Cardiol. 1992;  36 23-29
• 8 Bauer M, Alexi-Meskishvilli V, Nakic Z. et al . The correction of congenital heart defects with less invasive approaches.  Thorac Cardiovasc Surg. 2000;  48 67-71
• 9 Tiete A R, Sachweh J S, Kozlik-Feldmann R, Netz H, Reichart B, Daebritz S H. Minimally invasive surgery for congenital heart defects in paediatric patients.  Thorac Cardiovasc Surg. 2002;  50 271-275
• 10 Saunders P C, Grossi E A, Sharony R. et al . Minimally invasive technology for mitral valve surgery via left thoracotomy: Experience with forty cases.  J Thorac Cardiovasc Surg. 2004;  127 1026-1032
• 11 Cosgrove III D M, Sabik J F, Navia J L. Minimally invasive valve operations.  Ann Thorac Surg. 1998;  65 1535-1539
• 12 Loulmet D F, Carpentier A, Cho P W. et al . Less invasive techniques for mitral valve surgery.  J Thorac Cardiovasc Surg. 1998;  115 772-779
• 13 Massetti M, Babatasi G, Rossi A. et al . Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome.  Ann Thorac Surg. 1996;  62 1100-1103
• 14 Cooley D A. Minimally invasive valve surgery versus the conventional approach.  Ann Thorac Surg. 1998;  66 1101-1105
• 15 Bleiziffer S, Schreiber C, Kostolny M. et al .Cosmetic outcome of right anterolateral thoracotomy in pre-pubescent female patients. 16^th Annual meeting of the EACTS. 189I. 
• 16 Detter C, Deuse T, Boehm D H, Reichenspurner H, Reichart B. Midterm results and quality of life after minimally invasive vs. conventional aortic valve replacement.  Thorac Cardiovasc Surg. 2002;  50 337-341

1 Abstract presentation: As poster at the Association for European Paediatric Cardiology, Munich, 19 - 22 May 2004, Abstract number P98