Comparison of Ministernotomy with Minithoracotomy Regarding Postoperative Pain and Internal Mammary Artery Characteristics

(#2000-0099 ... June 8, 2000)

Naresh Trehan, MD, Rajneesh Malhotra, MCh, Yugal Mishra, PhD, Sameer Shrivastva, DM, Vijay Kohli, MCh, Yatin Mehta, MD, FRCA

Escorts Heart Institute and Research Centre, New Delhi, India

ABSTRACT

Purpose: This prospective clinical study focuses on postoperative pain and internal mammary artery (IMA) characteristics after ministernotomy versus left anterior minithoracotomy.

Method: Patients were studied in two groups. Group A consisted of 267 consecutive single vessel (IMA to left anterior descending artery (LAD)) minimally invasive direct coronary artery bypass (MIDCAB) patients using ministernotomy from the tip of the xiphoid to the fourth intercostal space. Group B consisted of the same number of MIDCAB patients operated on through anterolateral minithoracotomy. Pain was graduated using the visual analog scale (VAS). Internal mammary artery (IMA) characteristics were compared in both the 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 patients had less pain than Group B patients (p < 0.05), and the pain medication requirement from POD 2 onwards was less in Group A than in Group B. Length 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, anterolateral minithoracotomy patients suffer more pain from POD 2 onwards and their postoperative pain medication requirement is also higher. Length and free flow of IMA is better in patients operated on for MIDCAB using ministernotomy. Thus, ministernotomy is a better approach than minithoracotomy in terms of postoperative pain and IMA characteristics for single-vessel MIDCAB patients.

AUTHOR/ARTICLE INFORMATION

Presented at the Third Annual Meeting of the International Society for Minimally Invasive Cardiac Surgery, Atlanta, Georgia, June 8-10, 2000.

Address correspondence and reprint request to: Dr. Rajneesh Malhotra, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi-110025, India, Phone: 0091-11-6825000, 0091-11-6825001, Fax: 0091-11-6825013, Email: malhotrarajneesh@hotmail.com ; ehirc@vsnl.com

Keywords: coronary bypass, ministernotomy, minithoracotomy, postoperative pain, MIDCAB, LIMA, LAD.