Background/Objectives: Minimally invasive valve surgery (MIVS) is increasingly employed as an alternative to conventional median sternotomy (MS) in the treatment of valvular heart disease. However, its impact on postoperative quality of life (QoL) remains incompletely understood. This systematic review and meta-analysis aimed to compare QoL outcomes between MIVS and MS, focusing on physical, psychological, and social dimensions, both in the short- and long-term postoperative periods. Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Wiley Online Library databases for studies published between January 2020 and September 2025. Eligible studies included adult patients undergoing MIVS or MS and assessed QoL using validated instruments (SF-36, EQ-5D, MLHFQ, KCCQ). Random-effects models were used for meta-analysis, and standardized mean differences (SMDs) were calculated to estimate pooled effects. Results: Fifty-six studies with a combined sample of over 10,000 patients were included. MIVS was associated with significantly better short-term QoL outcomes across physical (SMD = 0.88; 95% CI: 0.74–1.02) and psychological domains (SMD = 0.47; 95% CI: 0.35–0.59). Patients also experienced earlier social reintegration and improved body image perception. Although these benefits diminished beyond 12 months, MIVS maintained a modest but persistent advantage in long-term QoL (≥5 years). Structured psychological support and cardiac rehabilitation programmes further enhanced physical and emotional recovery. Conclusions: MIVS confers meaningful benefits in postoperative QoL, particularly during the early recovery phase. Sustained improvements depend on comprehensive postoperative care, including rehabilitation and psychosocial support. Further long-term, standardized research is required to strengthen evidence and guide patient-centred surgical decision-making.

Valvular heart disease represents a significant burden on global health, and its impact on health-related quality of life (HRQOL) is increasingly recognized in clinical decision-making. This integrative review synthesized outcomes measured with the 36-Item Short Form Health Survey (SF-36). A structured PubMed search was conducted in November-December 2024 and updated in September 2025; studies published from 2014 onward that reported SF-36 after heart valve interventions were included. Twelve studies met the criteria, spanning surgical and transcatheter approaches and both mechanical and biological prostheses. Across studies, early (≤1 month) improvements were evident, with the largest gains typically in physical domains. Mid-term (six to 12 months) improvements were generally sustained, and differences between transcatheter and surgical approaches tended to attenuate, with no consistent between-group differences by six to 12 months in studies reporting adjusted comparisons. Age-related patterns were observed: older patients started lower and showed smaller absolute gains in physical domains, while mental health changes were more modest and often comparable across ages. Findings comparing mechanical versus biological valves were heterogeneous and likely influenced by confounding (age, comorbidity, anticoagulation). Longer-term (>12 months) trajectories remain uncertain due to limited longitudinal data. Limitations include the single-database search restricted to English-language and free full-text articles, variability in follow-up windows and reporting, and the absence of a formal meta-analysis or risk-of-bias grading. Despite these constraints, current evidence indicates that heart valve interventions improve HRQOL, supporting shared decision-making and the need for standardized time points, adjusted analyses, and longer follow-up to refine comparative inferences.

Background Health-related quality of life (HRQoL) has become an essential patient-centered outcome in modern cardiovascular care, particularly following heart valve interventions. Although advances in surgical and transcatheter therapies have markedly improved survival, real-world implementation of standardized patient-reported outcome measures (PROMs) remains limited due to feasibility concerns. This study aimed to evaluate the feasibility of EQ-5D (EuroQoL-5 Dimensions) and EQ-VAS (EuroQoL Visual Analogue Scale) implementation in routine postoperative follow-up and to explore associations between HRQoL and selected clinical variables. Methods This single-center cross-sectional pilot feasibility study included consecutive adult patients who had undergone surgical or transcatheter heart valve interventions and attended routine postoperative follow-up approximately two to four months after intervention. HRQoL was assessed using the EQ-5D questionnaire and EQ-VAS. A Global Rating of Change question evaluated perceived health status relative to the pre-intervention period. Clinical and procedural data were extracted retrospectively from medical records. Feasibility outcomes included completion rate, independence of questionnaire completion, and absence of missing data. Associations between EQ-VAS scores and clinical variables were explored using nonparametric analyses. Results Among 40 eligible patients, 34 (85.0%) completed the HRQoL assessment without missing responses or needing assistance, demonstrating excellent feasibility. The mean EQ-VAS score was 79.4 ± 13.2. Overall, 12 (35.3%) of patients reported full health status across all EQ-5D domains. Functional limitations were uncommon, with mobility impairment reported by 3 (8.8%) patients and self-care and usual activity limitations each by 5 (14.7%), while pain/discomfort (11, or 32.4%) and anxiety/depression (9, or 26.5%) were the most frequent concerns. Most patients, 28 (82.4%), perceived their health as improved compared to the pre-intervention period. Clinically significant postoperative complications occurred in 2 (5.9%) patients and were associated with significantly lower EQ-VAS scores (p = 0.046). Conclusions Implementation of EQ-5D and EQ-VAS in routine postoperative follow-up after heart valve interventions is feasible, well accepted by patients, and provides meaningful insights into perceived recovery. These findings support the integration of pragmatic HRQoL assessment into real-world cardiovascular practice and provide a foundation for future longitudinal studies evaluating the role of patient-reported outcomes in guiding patient-centered care.

Health-related quality of life (HRQoL) has become a pivotal outcome in valvular heart disease (VHD), complementing mortality and readmission. This narrative (non-systematic) review synthesizes validated HRQoL instruments used in VHD, spanning generic tools - the Short Form-36 and derivatives (SF-12, SF-6D), EuroQol 5-Dimensions (EQ-5D), and World Health Organization Quality of Life - Brief (WHOQOL-BREF) - and disease-specific measures such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Instruments were included if (i) applied to adult VHD populations or valve interventions or (ii) demonstrated use in VHD cohorts; English-language sources (primarily 2015-2025) were prioritized, retaining seminal pre-2015 validation papers. Pediatric-only cohorts, non-validated tools, and case reports were excluded. MLHFQ and KCCQ were included on an evidence basis: both have been validated in valvular populations and used as key endpoints in pivotal interventional studies, demonstrating high reliability and sensitivity to change after surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVI), and transcateter edge-to-edge repair (TEER). Their established minimal clinically important differences and the availability of a short form (KCCQ-12) further support feasibility and interpretability in practice. The review is descriptive and therefore psychometric properties (validity, reliability, responsiveness, minimal clinically important differences), covered domains, feasibility, and cultural/linguistic adaptation are summarized from existing studies. Emphasis is placed on domains most germane to VHD recovery - physical function, symptom burden, emotional well-being, and social/role participation - given their sensitivity to peri-interventional change. Recommendations for clinical integration (e.g., pairing a generic utility measure such as EQ-5D with a disease-specific tool such as KCCQ; standardized assessment at baseline, 30 days, six and 12 months) are evidence-informed (randomized trials, registries, guidelines). Key gaps include limited valve-specific content (e.g., prosthesis noise, anticoagulation burden), heterogeneity in instruments and time points, incomplete cultural validation, and scarce HRQoL data for emerging therapies (e.g. transcatheter mitral valve replacement, contemporary tricuspid interventions). As a narrative (non-systematic) purely descriptive synthesis, no formal risk-of-bias assessment or meta-analysis was conducted. The English-language restriction and heterogeneity across instruments and follow-up time points limit quantitative comparability and preclude definitive head-to-head conclusions. Future work should develop core outcome sets and VHD-specific modules, strengthen cross-cultural validation, and leverage digital patient-reported outcome platforms to improve comparability and clinical uptake.

To evaluate early clinical outcomes and hospital resource utilization across three treatment strategies for valvular heart disease: median sternotomy, righ

Purpose: Cardiac tamponade is an uncommon but potentially catastrophic complication of transcatheter aortic valve implantation (TAVI), particularly when caused by iatrogenic hemopericardium, with high mortality among patients requiring emergency cardiac surgery. We describe a structured minimally invasive subxiphoid protocol modification for immediate intraprocedural tamponade management and place this experience in the context of current evidence. Materials and Methods: Between January 2023 and April 2026, cardiac tamponade developed intra- or peri-procedurally in 4 consecutive patients among approximately 350 TAVI procedures at a single tertiary center. The protocol comprised immediate subxiphoid decompression; insertion of two 16 Fr radiopaque Redon drains, placed anteriorly and posteriorly, each connected to a separate Drainobag bottle sustaining high negative pressure; hermetic layered closure; mechanical ventilation under sedation after decompression for at least 12 hours and progressive drain removal after 72 hours. Results: All 4 patients achieved immediate hemodynamic recovery without conversion to emergency sternotomy. No hospital deaths or procedure-related complications occurred. No late pericardial reaccumulation, constrictive pericarditis or ventricular pseudoaneurysm occurred. Conclusion: In this small single-center series, dual-drain subxiphoid drainage with continuous high-vacuum aspiration was feasible and associated with hemodynamic recovery without emergency sternotomy in 4 selected TAVI patients. Larger comparative studies are required before broader use can be recommended. These observations should be considered hypothesis-generating. Clinical Impact: Cardiac tamponade during TAVI requires rapid, mechanism-directed treatment. Image-guided pericardiocentesis remains the usual first drainage step, whereas ongoing iatrogenic hemopericardium or failure to stabilize requires immediate surgical escalation. In 4 carefully selected patients, dual-drain subxiphoid decompression with continuous high-vacuum aspiration restored hemodynamic stability without emergency sternotomy. These findings support its feasibility as a rescue option in carefully selected cases, while larger comparative studies are needed to define its hemostatic effectiveness and its role relative to conventional drainage. Persistent bleeding or recurrent hemodynamic instability should prompt surgical conversion.