Comparison of ministernotomy with minithoracotomy regarding postoperative pain and internal mammary artery characteristics

Citation
N. Trehan et al., Comparison of ministernotomy with minithoracotomy regarding postoperative pain and internal mammary artery characteristics, HEART SUR F, 3(4), 2000, pp. 300-306
Citations number
13
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
HEART SURGERY FORUM
ISSN journal
1098-3511 → ACNP
Volume
3
Issue
4
Year of publication
2000
Pages
300 - 306
Database
ISI
SICI code
1098-3511(2000)3:4<300:COMWMR>2.0.ZU;2-J
Abstract
PURPOSE: This prospective clinical study focuses on postoperative pain and internal mammary artery (IMA) characteristics after ministernotomy versus l eft anterior minithoracotomy. METHOD: Patients were studied in two groups. Group A consisted of 267 conse cutive single vessel (IMA to left anterior descending artery (LAD)) minimal ly invasive direct coronary artery bypass (MIDCAB) patients using ministern otomy from the tip of the xiphoid to the fourth intercostal space. Group B consisted of the same number of MIDCAB patients operated on through anterol ateral minithoracotomy. Pain was graduated using the visual analog scale (V AS). Internal mammary artery (IMA) characteristics were compared in both th e groups. RESULTS: Postoperative pain was not significant statistically on postop day (POD) 1 in either of the groups (p = 0.07). From POD 2 onwards Group A pat ients had less pain than Group B patients (p < 0.05), and the pain medicati on requirement from POD 2 onwards was less in Group A than in Group B. Leng th of harvested IMA was 15.6 +/- 2.1 cm in Group A as compared to 10.4 +/- 2.2 cm in Group B (p < 0.05). Free flow of IMA in group A was 56 +/- 16 ml/ min., whereas in Group B the flow was 50 +/- 14 ml/min. (p = 0.04). CONCLUSION: Compared to patients undergoing MIDCAB using ministernotomy, an terolateral minithoracotomy patients suffer more pain from POD 2 onwards an d their postoperative pain medication requirement is also higher. Length an d free flow of IMA is better in patients operated on for MIDCAB using minis ternotomy. Thus, ministernotomy is a better approach than minithoracotomy i n terms of postoperative pain and IMA characteristics for single-vessel MID CAB patients.