The Scar Cosmesis Assessment and Rating scale to Evaluate the Cosmetic Outcomes of the Totally Thoracoscopic Cardiac Surgery

Background: Conventional median sternotomy is widespread used in cardiac surgery, while the multiple-incision totally thoracoscopic cardiac surgery which is considered to have aesthetic advantages now is increasingly used in china because patients' requirements for minimally invasive and aesthetically pleasing are significantly increased. Fewer studies have been conducted on the assessment of surgical scars after cardiac surgery. Compared to a median sternotomy approach, totally thoracoscopic cardiac surgery offers smaller but numerous and scattered incisions, requiring two surgical incisions on the upper and lower margins of the right breast, as well as an inguinal incision and an axillary incision. So, does totally thoracoscopic cardiac surgery really have aesthetic advantages? This study has the following objectives: (a) to compare the long term cosmetic effect of post-operative scars between median sternotomy cardiac surgery and totally thoracoscopic cardiac surgery; (b) to evaluate the effectiveness of the Scar Cosmesis Assessment and Rating(SCAR) scale, in combination with the Numeric Rating Scale(NRS) in the assessment of surgical scars after cardiac surgery. Methods: : Collection of consecutive patients who came to our institution from January 2019 to May 2019 for cardiac surgery via median sternotomy or totally thoracoscopic approach for at least one year of follow-up. Inter-rater reliability, internal consistency and convergent validity were evaluated for the SCAR scale and the NRS. Clinic characteristics and the score of the SCAR scale and the NRS were analyzed using the Student's t test or Mann-Whitney U-test between the two groups. Results: : 31 patients underwent cardiac surgery via the totally thoracoscopic approach (TA n = 31), and 42 patients via the median sternotomy approach (SA n = 42). No significant differences were found in demographic and clinical data between the two groups. Validity and reliability of the SCAR scale and the NRS were satisfactory. The scores of “overall impression” and “patient questions” were obviously higher in the sternotomy group with statistical significance (P < 0.05). The overall SCAR scale scores and the NRS scores were statistically significant (P < 0.05). Conclusions: : The SCAR scale in combination with the NRS is an effective tool for scar assessment after cardiac surgery. Surgical scars of totally thoracoscopic cardiac surgery can achieve desirable cosmetic effects in Chinese population. Especially in susceptible individuals with high risk of keloid and hypertrophic scars. Patients with appropriate indications can undergo cardiac surgery through the totally thoracoscopic approach and obtain a satisfactory scar appearance.