Comparison of early postoperative quality of life in minimally invasive versus conventional valve surgery.
OBJECTIVE
Minimally invasive cardiac surgery (MICS), an approach in which full sternotomy is avoided and the surgical incision is minimal, has been shown to produce less postoperative discomfort and to enable earlier mobilization and discharge than conventional cardiac surgery (CCS). This study was performed to retrospectively evaluate quality of life following MICS in comparison with CCS valve surgery.


METHODS
Sixty-six patients scheduled for MICS and 50 patients scheduled for CCS for isolated aortic or mitral valve surgery from January 1999 to June 2001 were enrolled in the study. The clinical records for the two groups were compared across intraoperative parameters and those associated with postoperative quality of life.


RESULTS
The aortic clamp and cardiopulmonary bypass times in the MICS group were longer than those in the CCS group (144 +/- 42 and 224 +/- 58min vs 112 +/- 21 and 179 +/- 27min, P < 0.001). Postoperative pain medication (rectal buprenorphine and intramuscular pethidine) was administered to 18 of the 66 MICS patients (27%), as compared with 26 of the 50 CCS patients (52%, P = 0.007). Postoperative delirium was less frequent in the MICS group than the CCS group (26% vs 44%, P = 0.039). Initial postoperative food intake and urine catheter removal were possible earlier in the MICS than in the CCS group. MICS patients had shorter stays in the intensive care unit than CCS patients (37.4 +/- 7.3 vs 45.9 +/- 8.7h, P < 0.001).


CONCLUSIONS
Although longer aortic clamp and cardiopulmonary bypass times remain a problem in MICS procedures, our results suggest that MICS, as compared with CCS, facilitates earlier recovery of daily activities and provides improved quality of life in the early postoperative period.
Yamada
Tatsuya
T
Department of Anesthesiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Ochiai
Ryoichi
R
Takeda
Junzo
J
Shin
Hankei
H
Yozu
Ryohei
R
D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011182:Postoperative Care; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies