Introduction

- Quality of Life (QoL) is an increasingly important outcome after cardiac surgery because it reflects patient-centered recovery, functional status, and overall well-being.

- Traditional median sternotomy is associated with greater surgical trauma, postoperative pain, and delayed recovery, whereas minimally invasive and robotic techniques may accelerate return to normal activities and improve QoL.

- Previous studies have shown QoL recovery around 3 months after minimally invasive or robotic cardiac procedures, but evidence remains inconsistent and predictors of early recovery are not well defined.

- The study aimed to evaluate short-term postoperative QoL recovery after robotic cardiac surgery, determine how many patients return to baseline QoL within 4 weeks, and identify factors associated with recovery.

Methods

- Prospective observational study conducted at a single institution between July 2021 and December 2024.

- Included 168 patients who underwent: 

- Robotic mitral valve repair (n = 96) 

- Minimally invasive direct coronary artery bypass (MIDCAB, n = 21) 

- Totally endoscopic coronary artery bypass (TECAB, n = 51)

Quality of life was measured preoperatively and 4 weeks postoperatively using: 

- EQ-5D-5L questionnaire (utility score) 

- Best Imaginable Health visual analog scale (0–100)

Return to baseline QoL was defined as a decline in EQ-5D utility score of no more than 0.05 points (ΔEQ-5D ≥ −0.05), based on the minimal clinically important difference (MCID).

Results

- The cohort had a median age of 62 years, and 73.1% were male. 

- Median EQ-5D utility scores remained stable from baseline to 4 weeks (0.943 vs. 0.940; p = 0.061), indicating preservation of overall QoL

- Self-rated health significantly improved, with Best Imaginable Health scores increasing from 80 to 85 (p < 0.001).

- Overall, 70.8% of patients returned to baseline QoL within 4 weeks. Recovery rates by procedure type were: 

- Mitral valve repair: 67% 

- MIDCAB: 81% 

- TECAB: 75%

- Patients who returned to baseline were more likely to have higher preoperative symptom burden (NYHA III/IV), whereas those who did not recover had a higher prevalence of sleep apnea.

- Intraoperative factors such as cardiopulmonary bypass time, procedure duration, and conversion to sternotomy were not significantly associated with QoL recovery.

- Multivariable analysis showed: 

- Higher NYHA class (III/IV) increased the likelihood of returning to baseline QoL (OR 4.14; p = 0.025). 

- Diabetes reduced the likelihood of recovery (OR 0.20; p = 0.004). 

- Higher preoperative EQ-5D scores were strongly associated with lower odds of returning to baseline, likely due to a ceiling effect.

Conclusions

In this mixed robotic cardiac surgery cohort, most patients returned to their preoperative quality of life baseline within 4 weeks. Higher NYHA class and lower baseline EQ-5D scores were associated with achieving return to baseline, whereas diabetes and higher preoperative EQ-5D scores were associated with lower odds.