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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Comparison of ministernotomy with minithoracotomy regarding postoperative pain and internal mammary artery
N Trehan1, R Malhotra, Y Mishra
1Escorts Heart Institute and Research Centre, New Delhi, India.
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.
