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
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.