Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement

Brian Gebhardt, Ankit Jain, Sarah Basaham, Farhad Zahedi, Stefan Ianchulev, Larry Brinckerhoff, John Augoustides, Prakash Patel, Andrea Tsai, Frederick Cobey

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)239-245
Number of pages7
JournalAnnals of Cardiac Anaesthesia
Volume22
Issue number3
DOIs
StatePublished - Jul 1 2019
Externally publishedYes

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Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Gebhardt, B., Jain, A., Basaham, S., Zahedi, F., Ianchulev, S., Brinckerhoff, L., Augoustides, J., Patel, P., Tsai, A., & Cobey, F. (2019). Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement. Annals of Cardiac Anaesthesia, 22(3), 239-245. https://doi.org/10.4103/aca.ACA_77_18